TABLE OF CONTENTS - Drug Plan

Transcription

Saskatchewan
Health
Formulary
Fifty-Second Edition
Drug Plan
October 2002 - July 2003
Updated quarterly
Inquiries should be directed to:
Pharmaceutical Services Division
Drug Plan & Extended Benefits Branch
Saskatchewan Health
2nd Floor, 3475 Albert Street
Regina, Saskatchewan
S4S 6X6
Website Address: http://formulary.drugplan.health.gov.sk.ca
Telephone inquiries should be directed as follows:
Consumer Inquiries………………..……………Toll Free……..
…………………………………………….……...Regina….…..
Pharmacy Inquiries………………………………Toll Free…….
………………………………………………..……Regina………
Special Support Program Inquiries……………Toll Free……..
…………………………………………….……....Regina….…...
EDS, Palliative Care, "No Substitution" Inquiries…….……….
EDS Requests (24-hour message system)…..Toll Free……..
Profile Release Program………………………………………...
Pricing, Contract Inquiries……………………………………….
Product Submission Inquiries………………………….………..
Research and Utilization Inquiries……………………………...
Hospital Benefit List Inquiries………………………….………..
1-800-667-7581
(306) 787-3317
1-800-667-7578
(306) 787-3315
1-800-667-7581
(306) 787-3317
(306) 787-8744
1-800-667-2549
(306) 787-1661
(306) 787-3420
(306) 933-5599
(306) 787-3307
(306) 787-3224
Facsimile numbers:
EDS Unit Fax (EDS requests, Palliative Care forms and "No
Substitution" requests only)…………………….
General Fax ………………………………………..…..………...
(306) 798-1089
(306) 787-8679
Copyright - 2002
Her Majesty the Queen in right of the
Dominion of Canada, as represented
by the Minister of Health of the
Province of Saskatchewan.
ISSN 0701-9823
Printed in Canada
Saskatchewan Health
Government of Saskatchewan
Minister,
The Honourable John T. Nilson, Q.C.
TABLE OF CONTENTS
The Saskatchewan Formulary Is
Published Annually
Updates will be provided:
Winter 2003
Spring 2003
Please insert sticker updates in the section
provided at the back of the Formulary.
TABLE OF CONTENTS
MEMBERSHIP OF SASKATCHEWAN FORMULARY COMMITTEE.................................... .
MEMBERSHIP OF SASKATCHEWAN DRUG QUALITY ASSESSMENT COMMITTEE ..... .
PREFACE.............................................................................................................................. .
NOTES CONCERNING THE FORMULARY......................................................................... .
LEGEND................................................................................................................................ .
iv
iv
v
ix
xvii
PHARMACOLOGICAL - THERAPEUTIC CLASSIFICATION OF DRUGS
08:00 ANTI-INFECTIVE AGENTS..................................................................................... .
10:00 ANTINEOPLASTIC AGENTS.................................................................................. .
12:00 AUTONOMIC DRUGS............................................................................................. .
20:00 BLOOD FORMATION AND COAGULATION.......................................................... .
24:00 CARDIOVASCULAR DRUGS................................................................................. .
28:00 CENTRAL NERVOUS SYSTEM DRUGS............................................................... .
36:00 DIAGNOSTIC AGENTS.......................................................................................... .
40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE........................................... .
48:00 COUGH PREPARATIONS...................................................................................... .
52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS.............................................. .
56:00 GASTROINTESTINAL DRUGS............................................................................... .
60:00 GOLD COMPOUNDS.............................................................................................. .
64:00 METAL ANTAGONISTS.......................................................................................... .
68:00 HORMONES AND SUBSTITUTES......................................................................... .
84:00 SKIN AND MUCOUS MEMBRANE PREPARATIONS............................................ .
86:00 SMOOTH MUSCLE RELAXANTS.......................................................................... .
88:00 VITAMINS................................................................................................................ .
92:00 UNCLASSIFIED THERAPEUTIC AGENTS............................................................ .
2
24
28
40
46
76
120
124
130
132
144
154
156
158
180
202
206
210
APPENDICES
APPENDIX A - EXCEPTION DRUG STATUS PROGRAM................................................ .
APPENDIX B - HOSPITAL BENEFIT DRUG LIST............................................................. .
APPENDIX C - TIPS ON PRESCRIPTION WRITING........................................................ .
PRESCRIPTION REGULATIONS.............................................................. .
APPENDIX D - GUIDELINES FOR REPORTING ADVERSE DRUG REACTIONS.......... .
APPENDIX E - SPECIAL COVERAGES............................................................................ .
APPENDIX F - TRIPLICATE PRESCRIPTION PROGRAM............................................... .
APPENDIX G - CODES FOR PHARMACY ON-LINE CLAIMS PROCESSING................. .
APPENDIX H - MAINTENANCE DRUG SCHEDULE........................................................ .
APPENDIX I - TRIAL PRESCRIPTION PROGRAM MEDICATION LIST......................... .
APPENDIX J - SASKATCHEWAN MS DRUGS PROGRAM............................................. .
222
259
292
294
296
301
306
309
311
312
313
INDICES
INDEX A - PHARMACEUTICAL MANUFACTURERS LIST............................................... .
INDEX B - THERAPEUTIC CLASSIFICATION LIST......................................................... .
INDEX C - NUMERICAL LIST OF DRUG IDENTIFICATION NUMBERS.......................... .
INDEX D - ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCT NAMES.............. .
318
320
322
339
FORMULARY UPDATES...................................................................................................... .
UPDATE INDEX.......…………………………………............................................................... .
360
378
ii
INTRODUCTION
COMMITTEES
SASKATCHEWAN FORMULARY
COMMITTEE (SFC)
SASKATCHEWAN DRUG QUALITY
ASSESSMENT COMMITTEE (DQAC)
Dr. B.R. Schnell
Chairperson
Dr. D. Quest
Chairperson
Dr. M. Caughlin
Saskatchewan Medical Association
Ms B. Evans
College of Pharmacy & Nutrition
Ms S. Chow
Saskatchewan Registered Nurses
Association
Dr. I. Holmes
College of Medicine
Dr. A. Paus-Jenssen
College of Medicine
Dr. R. Dobson
Member at Large
Dr. A. K. Ramlall
College of Medicine
Mr. M. Gaucher
Saskatchewan Association of
Health Organizations
Dr. B.R. Schnell
Chair, SFC
Ms C. Kanhai
Saskatchewan Pharmaceutical
Association
Dr. Y. Shevchuk
Dr. J. de la Rey Nel
College of Physicians & Surgeons
Dr. J. Sibley
Department of Medicine,
College of Medicine
Mr. G. Peters
Saskatchewan Health
Dr. J. Tuchek
Department of Pharmacology,
College of Medicine
Dr. D. Quest
Chair, DQAC
Dr. T. W. Wilson
Departments of Medicine &
Pharmacology,
College of Medicine
Dr. D. Seibel
Member at Large
Dr. Y. Shevchuk
STAFF ASSISTANCE
Ms Barbara J. Shea
Executive Director,
Ms Gail Bradley
Pharmacist,
Mr. Kevin Wilson
Director, Pharmaceutical Services
Dr. Lorne Davis
Pharmacologist,
Ms Margaret Baker
Manager, Formulary & Special Benefits
iv
PREFACE
OBJECTIVES
The Drug Plan has been established to:
• provide coverage to Saskatchewan residents for quality pharmaceutical products of
proven therapeutic effectiveness;
• reduce the direct cost of prescription drugs to Saskatchewan residents;
• reduce the cost of drug materials;
• encourage the rational use of prescription drugs.
THE FORMULARY
The Saskatchewan Formulary is a listing of the therapeutically effective drugs of proven
high quality that have been approved for coverage under the Drug Plan. It is compiled by
the Minister of Health with the advice of the Saskatchewan Formulary Committee (SFC).
The SFC is advised and assisted by the Drug Quality Assessment Committee (DQAC).
Members of both committees are appointed by the Minister of Health.
The Saskatchewan Formulary is published annually in July, with quarterly updates.
The ongoing work of the SFC includes the evaluation of new drug products as they are
introduced, and the periodic re-evaluation of all products. The goal is to list a range and
variety of drugs that will enable prescribers to select an effective course of therapy for
most patients.
THE DRUG REVIEW PROCESS
When a new drug is introduced to the Canadian market, the manufacturer submits a
request to the Drug Plan so that it can be considered for possible coverage. The request
must be supported by scientific reports and manufacturing documents to show that the
product meets accepted standards of quality, effectiveness and safety.
The DQAC carries out an initial evaluation of the submission, with emphasis on clinical
documents, such as reports of scientific studies comparing the new product with existing
therapeutic alternatives. In the case of new brands of currently listed products, the
DQAC evaluates comparative bioavailability studies and/or comparative clinical studies in
order to determine compliance with accepted standards for interchangeability.
The DQAC reports its findings to the SFC. Using this information, along with additional
details of anticipated cost and impact on patterns of practice, the SFC makes a
recommendation to the Minister of Health. These recommendations reflect the "Policy for
Inclusion of Products in the Saskatchewan Formulary" (see pages ix-xii).
The membership on the two Committees reflects their unique but complementary
mandate. The DQAC is composed of clinical specialists in internal medicine and/or
pharmacology, clinical pharmacists and pharmacologists. The SFC is made up of
representatives of the associations or institutions related to the regulation, education,
delivery and payment of drug therapy in Saskatchewan.
v
PRODUCT SUBMISSION PROCESS
MANUFACTURER
SUBMISSION
MANUFACTURER
SUBMISSION
ONCOLOGY INDICATION
DRUG QUALITY
ASSESSMENT COMMITTEE
(DQAC)
The DQAC reviews the clinical
and pharmaceutical aspects of
the submission and makes a
recommendation to the
Formulary Committee or the
Advisory Committee on
Institutional Pharmacy Practice.
AMBULATORY CARE INDICATION
INSTITUTIONAL INDICATION
SASKATCHEWAN
CANCER AGENCY
PHARMACY & THERAPEUTICS
COMMITTEE 2
SASKATCHEWAN
FORMULARY COMMITTEE
(SFC) 1
SASKATCHEWAN
CANCER AGENCY
BENEFIT DRUG LIST
ADVISORY COMMITTEE
ON INSTITUTIONAL
PHARMACY PRACTICE 3
HOSPITAL BENEFIT
DRUG LIST
SASKATCHEWAN
FORMULARY
1
2
3
Considers pharmacoeconomic impact in addition to the clinical and pharmaceutical aspects reviewed
by the DQAC.
DQAC advises the Saskatchewan Cancer Agency Pharmacy & Therapeutics Committee regarding
interchangeability and product quality issues.
All products listed in the Saskatchewan Formulary are benefits when used in the hospital setting.
Note: All committee recommendations are subject to approval by the Minister of Health.
vi
REQUEST FOR PRODUCT ASSESSMENT
Submission Process
Any supplier wishing to have products listed in the Saskatchewan Formulary, the Hospital
Benefits List or the Saskatchewan Cancer Agency Benefit List may submit requests for
product assessment. The route a submission follows is determined by the indication of
the products. There is no deadline date for submissions for listing in the Formulary. In
general, submissions are reviewed in order of receipt.
Clinical Documentation
Single-Supplier Product Submissions
Clinical documentation in support of products to be reviewed may be submitted at any
time. The committees meet on a regular basis and will review submissions as quickly as
possible upon receipt. Details of the criteria for product listings are published in each
edition of the Formulary and in the quarterly updates to the Formulary.
Clinical information should clearly illustrate the efficacy of the drug. Comparative studies
against listed products demonstrating specific advantages of the drug should be included.
Clinical data is not usually required for additional strengths of a dosage form unless the
additional strength is intended for different indications, than listed products. Rationale for
the additional strength should be included.
Notification is required whenever there is a change in formulation or in the clinical
information published in the product monograph, for any listed product as well as for any
product under review.
Interchangeable Product Submissions
Comprehensive clinical data may not be required for new brands of drugs already listed
in the Formulary. When a product may be considered as interchangeable with a listed
product, the submission should include documentation to demonstrate bioequivalence.
Comparative bioavailability data for one strength will apply to other strengths of the same
product if they are dose proportionate.
For solid oral dosage forms, comparative dissolution rate studies should be submitted.
For topical preparations, oral liquids and injectable drug products, comparative physical
parameters (e.g. viscosity, homogeneity, specific gravity, particle size distribution, pH,
osmolarity, drop size, drug content per drop, surface tension, etc.) to demonstrate
pharmaceutical equivalence.
For a cross-referenced product, letters dated and signed by a senior company official
from both the manufacturer making the submission, and the manufacturer of the crossreferenced product, should be submitted to confirm that the product is identical in all
aspects, except for embossing and labelling.
Manufacturing Documentation
Manufacturing documentation, completed Certified Product Information Document
(C.P.I.D.) should be submitted with the clinical documentation if possible, but will be
accepted at a later date. A representative sample, packaged and labelled for sale in
Canada should also be included.
vii
Economic Evaluation
Price information including catalogue or estimated prices should be provided at the time
of product submission.
Submission of pharmacoeconomic analyses are encouraged.
The National
Pharmacoeconomic Guidelines serve as a guide. The Formulary Committee will
routinely consider direct “medical” costs such as:
•
•
•
•
•
impact on laboratory tests for monitoring, evaluation or diagnosis
impact on physician office visits
impact on hospitalization or institutionalization
impact on surgical procedures
increased or decreased incidence and severity of side effects.
The availability of quality-of-life analyses is encouraged.
Additional Documentation Required:
• A letter authorizing unrestricted communication regarding the drug product between
the Saskatchewan Prescription Drug Plan and other federal, provincial and territorial
(F/P/T) drug programs:
1. F/P/T health authorities and related facilities
2. Health Canada
3. Patented Medicine Prices Review Board (PMPRB)
4. Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
• Expected market share information is requested to allow for an accurate projection
of the impact of a new product.
• Product patent expiration date is requested to allow for consideration of the potential
long-term economic impact of the product.
• Copies of the initial product launch material, and any subsequent promotional
material sent to physicians and pharmacists.
Submission Procedure
Requests for product assessment, together with supporting clinical (including
notice of compliance and product monograph) and manufacturing documentation
should be sent to:
Dr. Lorne Davis, Pharmacologist
Department of Pharmacology, College of Medicine
University of Saskatchewan, 107 Wiggins Road
Saskatoon, Saskatchewan S7N 5E5
Copies of the covering letter, the product monograph, notice of compliance,
pricing information and economic analysis should be sent to:
Ms Margaret Baker, Manager, Formulary & Special Benefits Unit
Drug Plan and Extended Benefits Branch, Saskatchewan Health
Regina, Saskatchewan S4S 6X6
viii
NOTES CONCERNING THE FORMULARY
Benefits
The Saskatchewan Formulary lists the drugs which are covered by the Drug Plan. A
prescription is required for all drugs dispensed under the Drug Plan with the exception of
insulin, blood-testing agents, and urine-testing agents used by diabetic patients. Certain
drugs are covered under the Exception Drug Status Program (EDS) and require that
specific medical criteria are met before coverage is granted. See Appendix A for more
information regarding EDS.
Eligibility
With a few exceptions, all Saskatchewan residents with a valid Saskatchewan Health
Services card are eligible for coverage under the Drug Plan. The exceptions include
those who have prescription costs paid by another agency. For example:
•
•
•
•
•
Health Canada, First Nations and Inuit Health Branch
Workers' Compensation Board
Veterans Affairs Canada
members of the Royal Canadian Mounted Police
members of the Canadian Forces
Policy for Inclusion of Products in the Saskatchewan Formulary
1.
Only products produced by manufacturers approved as acceptable suppliers by the
SFC will be considered.
Companies without their own manufacturing facilities may be recognized as
approved suppliers if, in addition to meeting all other criteria outlined herein, they
provide adequate assurance that the product supplied is made under an acceptable
contractual arrangement which is approved by the SFC.
The procedures used to evaluate a drug manufacturer include:
• review of manufacturing facilities and procedures by:
• manufacturers' reports to the Committee;
• evaluation of selected documents pertaining to individual products;
• laboratory analysis of products selected for testing;
• exchange of information and views with Health Canada, and the Food and Drug
Administration (Washington), on products and manufacturers, as well as studies
relating to particular problems such as dissolution and bioavailability;
• reference to experience and knowledge available to the Committee with relation to
manufacturing practices and drug usage at the clinical level.
The review of drug manufacturers is ongoing to ensure that the quality of products
listed in the Saskatchewan Formulary is maintained.
2.
Only drug products formulated and produced in accordance with sound
manufacturing principles and found to comply with official standards will be
considered.
The official standards include:
• regulations under the Food and Drugs Act pertaining to drug manufacturing;
ix
• Good Manufacturing Practices for Drug Manufacturers and Importers, 3rd Edition,
1989- Health Canada;
• official compendia-B.P., U.S.P., N.F. and/or appropriate in-house standards;
• similar criteria, where applicable, as defined by International (WHO), U.S., and
British authorities.
3.
Only drug products which are valid therapeutic agents, with proven clinical
effectiveness, for the diagnosis, prevention or treatment of mental or physical
disorders will be listed. The availability of suitable alternative agents, and potential
for undesirable effects will be considered.
The medical literature and clinical studies, supplied by the manufacturers or
Committee members, are reviewed and evaluated to determine if the drug product is
therapeutically effective for the treatment of the condition(s) for which the drug is
indicated.
The clinical literature is also reviewed to determine the therapeutic advantages or
disadvantages in relation to alternative agents, which may or may not be listed in the
Saskatchewan Formulary.
The rate and severity of potential undesirable effects are reviewed and compared
with those for alternative products.
In reviewing products for which suitable alternatives are listed in the Formulary,
consideration will be given to the following additional criteria:
• clinical documentation must clearly demonstrate therapeutic advantages such as:
• more effective for treatment of the condition(s) for which the drug is intended;
• increased safety as shown by reduced toxicity and reduced incidence of
adverse reactions and/or side effects;
• improved dosing schedule;
• reduced potential for abuse or inappropriate use;
OR
• anticipated cost of a product of equivalent therapeutic effectiveness must offer a
potential economic advantage over listed alternatives.
4.
The cost of therapy relative to the clinical efficacy is reviewed and compared to the
cost of therapy relative to the clinical efficacy of alternative agents.
An increased cost may be justified if the drug product produces better clinical results
in a significant portion of the patient population, demonstrates fewer or less severe
undesirable effects, or has a dosage regime which improves patient compliance.
The cost of oral combination products relative to the combined costs of the single
entities, the cost of the various dosage strengths relative to therapeutic advantages,
and the cost of additional dosage forms relative to the therapeutic advantages will be
considered when reviewing such products.
5.
Some drug products will not be listed as regular benefits, but may be made available
on Exception Drug Status for treatment of selected clinical indications. (See
Appendix A)
x
6.
Oral combination products are required to meet the following additional criteria:
• each component must make a contribution to the claimed effect;
• the dosage of each component (amount, frequency, duration of therapeutic effect)
must be such that the combination is safe and effective for a significant patient
population, requiring such concurrent therapy as defined in the labelling;
• a component may be added to:
• enhance safety or effectiveness of the principal active ingredient;
• minimize the potential for abuse of the principal active ingredient.
• combination fixed ratio must be "right" for:
• significant portion of patients;
• significant amount of natural history of disease.
• the manufacturer must provide the standards he has adopted for the product (inhouse or other) and these standards must be acceptable to the DQAC;
• the manufacturer must provide evidence that he can consistently meet these
standards.
7.
Sustained, prolonged or delayed release dosage forms are required to meet the
following additional criteria:
• clinical studies have demonstrated the sustained, prolonged or delayed action of
the active ingredient;
• the dosage form possesses therapeutic advantages in the treatment of the
disease entity for which the product is indicated;
• the manufacturer must provide the standards he has adopted for the product (inhouse or other) and these standards must be acceptable to the DQAC;
• the manufacturer must provide evidence that he can consistently meet these
standards.
8.
The various strengths of one dosage form will be considered if they possess
therapeutic advantages and meet the required standards for quality and cost.
9.
The various dosage forms of a drug product will be evaluated individually.
10. Drug products not listed in the Schedules of the Food and Drugs Act, Narcotic
Control Act or the Saskatchewan Pharmacy Act, but usually sold on prescription, will
be considered for inclusion.
11. Products which contain the same amount of the same active ingredient in an
equivalent dosage form and are of acceptable equivalent therapeutic effectiveness
will be listed as interchangeable.
12. The following will not be listed:
•
•
•
•
fertility agents;
drugs used in erectile dysfunction;
certain over-the-counter preparations;
drugs used primarily in hospitals;
xi
• antineoplastic agents (these are provided to patients through the Saskatchewan
Cancer Agency);
• anti-tuberculosis drugs;
• blood derivatives – immune serum globulin for prophylaxis against infectious
hepatitis or measles or for treatment of immune deficiency disease is available
from the Health Offices.
• vaccines and sera - most immunological agents are available from the Health
Offices.
13. Drug products identified by trade names deemed to be inappropriate, confusing
and/or misleading may not be listed. Some examples include:
• products with similar or identical trade names but containing different active
ingredients;
• products with a different strength of ingredient, manufactured by the same
supplier, but with a different trade name.
Policy for Formulary Deletion
The Minister of Health may delete any product from the Saskatchewan Formulary under
the following circumstances:
1. Upon the recommendation of the SFC:
• where the standards of quality and/or production have altered and are not
considered to meet accepted standards;
• where new information demonstrates that the product does not have adequate
therapeutic benefit;
• where undesirable effects of the product make the continued listing of the product
inappropriate;
• where new products possessing clearly demonstrated therapeutic advantages
have been listed, thereby making the continued listing of the product unnecessary.
2. Upon the recommendation of the Drug Plan where there are undesirable financial,
supply or administrative implications to continued listing of a product, the Drug Plan
will consult with the SFC prior to making a recommendation. The comments of the
Committee will be brought to the attention of the Minister.
3. Where the Minister of Health believes a product should be deleted, the Minister will
consult with the SFC before making a final decision.
Exception Drug Status
Certain drug products may be considered for Exception Drug Status coverage under one
or more of the following circumstances:
• the drug is ordinarily administered only to hospital inpatients and is being
administered outside of a hospital because of unusual circumstances;
• the drug is not ordinarily prescribed or administered in Saskatchewan but is being
prescribed because it is required in the diagnosis or treatment of a patient having
an illness, disability or condition rarely found in this province;
• the drug is infrequently used since therapeutic alternatives listed in the Formulary
are usually effective but are contraindicated or found to be ineffective because of
the clinical condition of the patient;
• the drug has been deleted from the Formulary, but is required by patients who
were previously stabilized on the drug;
xii
• the drug has potential for use in other than approved indications;
• the drug has potential for the development of widespread inappropriate use;
• the drug is more expensive than listed alternatives and offers an advantage in only
a limited number of indications.
The following information is required to process Exception Drug Status requests:
•
patient name
•
patient Health Services Number (9 digits)
•
name of drug
•
diagnosis relevant to use of drug
•
prescriber name
•
prescriber phone number
Saskatchewan Prescription Drug Plan policy does not allow a fee to be charged to clients
for Exception Drug Status applications made to the Drug Plan on the client's behalf.
See Appendix A for further details regarding Exception Drug Status.
"No Substitution" Prescriptions
Drug Plan benefits will be based only on the lowest priced interchangeable brand as
listed in the Formulary. Credit towards established deductibles or thresholds (for income
based drug coverage under Special Support) will also be based on the lowest priced
interchangeable brand. Although the Formulary will continue to list all approved brands,
patients will, in addition to their normal share of cost, be responsible for any incremental
cost associated with the selection of a higher cost brand.
It is important to note that both generic and brand name products are manufactured
under the same standards of good manufacturing practice, and that only those brands
which meet the SFC's standards for bioequivalence are accepted as interchangeable in
Saskatchewan.
In cases where a patient experiences problems with a specific brand of a medication, a
prescriber may make application for exemption from the cost of the "no sub" brand. (See
Appendix E for details.)
Adverse Drug Reactions
The Health Protection Branch encourages the reporting of suspected adverse drug
reactions. In Saskatchewan, prescribers, pharmacists, and other health professionals
are encouraged to participate in the Sask ADR Program.
Suspected adverse reactions are reported by the observers to this program, which in
turn, will send the original report to the Health Protection Branch in Ottawa.
See Appendix D for forms and guidelines.
Index
Drug products are listed numerically by DIN (drug identification number) as well as
alphabetically by official name and brand name at the back of the Formulary.
xiii
Pharmacologic-Therapeutic Classification of Drugs
The drugs are classified according to the pharmacologic-therapeutic classification
developed by the American Society of Hospital Pharmacists for the purpose of the
American Hospital Formulary Service.
Permission to use this system has been granted by the American Society of Hospital
Pharmacists. The Society is not responsible for the accuracy of transpositions or
excerpts from the original content.
Within each therapeutic classification the drugs are listed alphabetically according to their
official names. Under each drug, acceptable products are listed. Drugs with multiple
uses may be listed in one or more classes.
Prescription Quantities
The Drug Plan places no limitation on the quantities of drugs that may be prescribed.
Prescribers shall exercise their professional judgment in determining the course and
duration of treatment for their patients. However, in most cases, the Drug Plan will not
pay benefits or credit deductibles for more than a 3-month supply of a drug at one time.
The quantity dispensed for one dispensing fee shall be determined by the terms of the
contract in force when the prescription was dispensed. For drugs listed on the Two
Month and 100 Day maintenance drug lists, refer to Appendix H. Because of possible
waste and the potential danger of storing large quantities of potent drugs in the home, the
Drug Plan does not encourage the dispensing of unreasonably large quantities of
prescription drugs.
Release of Patient Drug Profiles
Saskatchewan prescribers or pharmacists wishing to obtain a drug profile for patients in
their care may do so by submitting a written request, stating the patient's name, address,
date of birth and Health Services Number to the address below. The drug profile will
include all claims for Formulary and Exception Drug Status drugs submitted to the Drug
Plan on behalf of the patient in the previous 9-12 months.
Please submit written request to:
Executive Director
Saskatchewan Health
Regina, S4S 6X6
FAX: (306) 787-8679
xiv
LEGEND
LEGEND
11
Pharmacological-Therapeutic classification.
2
Pharmacological-Therapeutic sub-classification.
3
Nonproprietary or generic name of the drug.
4
An asterisk (*) to the left of a drug strength and dosage form indicates that the products listed
below are interchangeable.
5
An asterisk (*) to the right of a price indicates that the Drug Plan has negotiated a contract
price for that product.
Pharmacists will dispense these products except where a prescriber indicates "no
substitution" for a product in an interchangeable category (see page xiii).
In cases where contracts have been negotiated with two suppliers of an interchangeable
product, either brand may be used. The prices are expressed as decimal dollars.
66
The following symbol:⌧, to the left of a drug strength and dosage form indicates that the
products listed below are NOT interchangeable.
77
Drug strength and dosage form.
88
The Drug Identification Number (DIN), which has been assigned by Health Canada, uniquely
identifies the drug product and its manufacturer, name and strength of active ingredients,
route of administration, and pharmaceutical dosage form.
99
This product requires Exception Drug Status (EDS) approval (see Appendix A for EDS
criteria).
10 All active ingredients of combination products are listed.
10
11 Strengths of active ingredients are listed in the same order as the ingredients. This example
indicates that the tablet contains 100mg of levodopa and 25mg of carbidopa.
12 Brand name of drug.
12
13 Three letter identification code assigned to each manufacturer. The codes are listed in Index
13
near the back of the Formulary.
14 The size of vials or ampoules of injectables is listed in brackets.
14
15 The size of a tube of ophthalmic ointments is listed in brackets.
15
xvi
1
08:00 ANTI-INFECTIVE AGENTS
2
08:12.16 ANTIBIOTICS (PENICILLINS)
3
AMOXICILLIN (AMOXYCILLIN)
* 250MG CAPSULE
4
00865567
00406724
00628115
02181487
02238171
02239761
NU-AMOXI
NOVAMOXIN
APO-AMOXI
LIN-AMOX
GEN-AMOXICILLIN
MED-AMOXICILLIN
NXP
NOP
APX
LIN
GPM
MED
$
0.0898 *
0.1120
0.1120
0.1120
0.1120
0.1120
PMS
ICN
WYA
$
0.0814
0.1055
0.1321
BAY
$
2.7188
RTP
NXP
APX
NOP
BMY
$
0.4107
0.4107
0.4107
0.4107
0.6839
LUD
$
73.1900
SCH
SAB
$
4.3400
4.3400
CONJUGATED ESTROGENS
6
⌧
0.625MG TABLET
00587281
00265470
02043408
PMS-CONJUGATED ESTROGENS
C.E.S.
PREMARIN
CIPROFLOXACIN
7
500MG TABLET
8
02155966
10
11
CIPRO (EDS)
9
LEVODOPA/CARBIDOPA
* 100MG/25MG TABLET
02126168
02182823
02195941
02244495
00513997
RATIO-LEVODOPA/CARBIDOPA
NU-LEVOCARB
12
APO-LEVOCARB
NOVO-LEVOCARBIDOPA
SINEMET
13
FLUPENTHIXOL DECANOATE
20MG/ML INJECTION SOLUTION (10ML)
02156032
GENTAMICIN SO4
* 5MG/G OPHTHALMIC OINTMENT (3.5G)
00028339
02230888
14
FLUANXOL DEPOT
GARAMYCIN
GENTAMICIN SULFATE
xvii
15
5
ANTI-INFECTIVE AGENTS
8:00
08:04.00 AMEBICIDES
DIIODOHYDROXYQUIN
650MG TABLET
01997750
DIODOQUIN
GLW
$
0.7307
JAN
$
3.1592
BAY
$
5.7510
PFC
$
1.0444
PFC
$
0.2507
PFC
$
0.1719
08:08.00 ANTHELMINTICS
MEBENDAZOLE
100MG TABLET
00556734
VERMOX
PRAZIQUANTEL
600MG TABLET
02230897
BILTRICIDE
PYRANTEL PAMOATE
125MG TABLET
01944363
COMBANTRIN
50MG/ML ORAL SUSPENSION
01944355
COMBANTRIN
PYRVINIUM PAMOATE
02019809
VANQUIN
08:12.00 ANTIBIOTICS
ANTIBIOTIC ASSOCIATED COLITIS OR PSEUDOMEMBRANOUS ENTEROCOLITIS
IS A SEVERE POTENTIALLY FATAL COLITIS WHICH MAY FOLLOW THE
ADMINISTRATION OF ANTIBIOTICS, MOST COMMONLY CLINDAMYCIN.
THE SYNDROME IS CAUSED BY A BACTERIAL TOXIN.
PATIENTS FOR WHOM ANTIBIOTICS ARE PRESCRIBED SHOULD BE ADVISED
TO DISCONTINUE THERAPY AND REPORT TO THE PHYSICIAN IF A
PERSISTANT DIARRHEA DEVELOPS AND/OR IF BLOOD OR MUCUS APPEARS
IN THE STOOL, AND SHOULD BE ADVISED NOT TO USE ANTIDIARRHEAL
PREPARATIONS WHILE ON THESE DRUGS AS THEY MAY EXACERBATE THE
CONDITION.
RECOMMENDED TREATMENT INCLUDES STOPPING ANTIBIOTICS AS SOON AS
POSSIBLE, CAREFUL ATTENTION TO FLUIDS AND ELECTROLYTES AND THE
USE OF AN APPROPRIATE ANTIBIOTIC (SUCH AS ORALLY ADMINISTERED
METRONIDAZOLE OR VANCOMYCIN) DIRECTED AGAINST THE TOXIN
PRODUCING ORGANISM.
2
08:12.02 ANTIBIOTICS (AMINOGLYCOSIDES)
GENTAMICIN SO4
* 40MG/ML INJECTION SOLUTION (2ML)
00223824
02145758
02242652
GARAMYCIN
GENTAMICIN SULPHATE
GENTAMICIN
SCH
NOP
SAB
$
4.3000
4.3000
4.3000
CCL
$
51.1700
APX
GPM
PFI
$
11.0779
11.0779
15.1868
GPM
APX
PMS
PFI
$
3.5719
3.7693
3.7693
5.0581
GPM
APX
PMS
PFI
$
6.3354
6.6867
6.6867
9.2146
PFI
$
1.0126
SCH
$
0.2775
SCH
$
0.4697
TOBRAMYCIN
SEE APPENDIX A FOR EDS CRITERIA
60MG/ML INHALATION SOLUTION (5ML)
02239630
TOBI (EDS)
08:12.04 ANTIBIOTICS (ANTIFUNGALS)
FLUCONAZOLE
* 150MG CAPSULE
02241895
02245697
02141442
APO-FLUCONAZOLE
GEN-FLUCONAZOLE
DIFLUCAN
* 50MG TABLET
02245292
02237370
02245643
00891800
GEN-FLUCONAZOLE (EDS)
APO-FLUCONAZOLE (EDS)
PMS-FLUCONAZOLE (EDS)
DIFLUCAN (EDS)
* 100MG TABLET
02245293
02237371
02245644
00891819
DIFLUCAN (EDS)
10MG/ML POWDER FOR ORAL SUSPENSION
02024152
DIFLUCAN P.O.S. (EDS)
GRISEOFULVIN (ULTRA-FINE)
250MG TABLET
00028274
FULVICIN U/F
500MG TABLET
00028282
FULVICIN U/F
3
08:12.04 ANTIBIOTICS (ANTIFUNGALS)
ITRACONAZOLE
100MG CAPSULE
02047454
SPORANOX (EDS)
JAN
$
3.7975
JAN
$
0.8075
NXP
NOP
APX
MCL
$
1.2841
1.2841
1.2841
2.0383
RTP
$
0.0858
DOM
RTP
PMS
PPZ
$
0.0534
0.0566
0.0643
0.1978
APX
PMS
GPM
NOP
NVR
$
2.7391
2.7391
2.7391
2.7393
3.8712
10MG/ML ORAL SOLUTION
02231347
SPORANOX (EDS)
KETOCONAZOLE
* 200MG TABLET
02122197
02231061
02237235
00633836
NU-KETOCON (EDS)
NOVO-KETOCONAZOLE (EDS)
APO-KETOCONAZOLE (EDS)
NIZORAL (EDS)
NYSTATIN
500,000U TABLET
02194198
RATIO-NYSTATIN
* 100,000U/ML ORAL SUSPENSION
02125145
02194201
00792667
00248169
DOM-NYSTATIN
RATIO-NYSTATIN
PMS-NYSTATIN
MYCOSTATIN
TERBINAFINE HCL
* 250MG TABLET
02239893
02240807
02242503
02240346
02031116
APO-TERBINAFINE
PMS-TERBINAFINE
GEN-TERBINAFINE
NOVO-TERBINAFINE
LAMISIL
4
08:12.06 ANTIBIOTICS (CEPHALOSPORINS)
CEFACLOR
Note: All forms and strengths of cefaclor are scheduled to be delisted
from the Saskatchewan Formulary effective April 1, 2003.
* 250MG CAPSULE
02185830
02230263
02231432
02231691
02177633
PMS-CEFACLOR (EDS)
APO-CEFACLOR (EDS)
NU-CEFACLOR (EDS)
NOVO-CEFACLOR (EDS)
DOM-CEFACLOR (EDS)
PMS
APX
NXP
NOP
DOM
$
0.6977
0.6977
0.6977
0.6977
0.8722
PMS
APX
NXP
NOP
DOM
$
1.3699
1.3699
1.3699
1.3699
1.7124
PMS
APX
DOM
PMS
$
0.0827
0.0827
0.0930
0.1183
PMS
APX
DOM
PMS
$
0.1514
0.1514
0.1702
0.2164
PMS
APX
DOM
PMS
$
0.2181
0.2181
0.2450
0.3117
AVT
$
3.3570
AVT
$
0.3598
* 500MG CAPSULE
02185849
02230264
02231433
02231693
02177641
PMS-CEFACLOR (EDS)
APO-CEFACLOR (EDS)
NU-CEFACLOR (EDS)
NOVO-CEFACLOR (EDS)
DOM-CEFACLOR (EDS)
* 25MG/ML ORAL SUSPENSION
02185857
02237500
02177668
00465208
PMS-CEFACLOR (EDS)
APO-CEFACLOR (EDS)
DOM-CEFACLOR (EDS)
CECLOR (EDS)
02185865
02237501
02177676
00465216
PMS-CEFACLOR (EDS)
APO-CEFACLOR (EDS)
DOM-CEFACLOR (EDS)
CECLOR (EDS)
02185873
02237502
02177684
00832804
PMS-CEFACLOR (EDS)
APO-CEFACLOR (EDS)
DOM-CEFACLOR (EDS)
CECLOR BID (EDS)
CEFIXIME
400MG TABLET
02195984
SUPRAX (EDS)
02195992
SUPRAX (EDS)
5
08:12.06 ANTIBIOTICS (CEPHALOSPORINS)
CEFPROZIL
250MG TABLET
02163659
CEFZIL (EDS)
BMY
$
1.6601
BMY
$
3.2550
BMY
$
0.1622
BMY
$
0.3245
RTP
APX
GSK
$
1.0994
1.0994
1.5705
RTP
APX
GSK
$
2.1779
2.1779
3.1112
GSK
$
0.1736
NOP
$
0.1620
NOP
$
0.3240
NXP
NOP
APX
PMS
DOM
$
0.1272 *
0.1620
0.1620
0.1620
0.1966
NXP
NOP
APX
PMS
DOM
$
0.2544 *
0.3240
0.3240
0.3240
0.3871
NOP
$
0.0352
NOP
$
0.0712
500MG TABLET
02163667
CEFZIL (EDS)
02163675
CEFZIL (EDS)
02163683
CEFZIL (EDS)
CEFUROXIME AXETIL
* 250MG TABLET
02242656
02244393
02212277
RATIO-CEFUROXIME (EDS)
APO-CEFUROXIME (EDS)
CEFTIN (EDS)
* 500MG TABLET
02242657
02244394
02212285
CEFTIN (EDS)
02212307
CEFTIN (EDS)
CEPHALEXIN MONOHYDRATE
250MG CAPSULE
00342084
NOVO-LEXIN
500MG CAPSULE
00342114
NOVO-LEXIN
* 250MG TABLET
00865877
00583413
00768723
02177781
02177846
NU-CEPHALEX
NOVO-LEXIN
APO-CEPHALEX
PMS-CEPHALEXIN
DOM-CEPHALEXIN
* 500MG TABLET
00865885
00583421
00768715
02177803
02177854
NU-CEPHALEX
NOVO-LEXIN
APO-CEPHALEX
PMS-CEPHALEXIN
DOM-CEPHALEXIN
00342106
NOVO-LEXIN
00342092
NOVO-LEXIN
6
08:12.12 ANTIBIOTICS (MACROLIDES)
PRESCRIPTIONS FOR SOLID DOSAGE FORMS OF ERYTHROMYCIN SHOULD BE
FILLED WITH AN ERYTHROMYCIN BASE PREPARATION OF THE STRENGTH
PRESCRIBED; DISPENSE THE STEARATE AND ESTOLATE ONLY WHEN
SPECIFICALLY PRESCRIBED.
AZITHROMYCIN
250MG TABLET
02212021
ZITHROMAX (EDS)
PFI
$
5.3528
PFI
$
12.8464
PFI
$
1.1574
PFI
$
1.6722
ABB
$
1.6048
ABB
$
3.2095
ABB
$
2.7282
ABB
$
0.2817
ABB
$
0.5632
APX
$
0.1107
ABB
$
0.5137
PFI
$
0.5024
PFI
$
0.5581
NOP
$
0.0297
NOP
$
0.0598
600MG TABLET
02231143
ZITHROMAX (EDS)
02223716
ZITHROMAX (EDS)
02223724
ZITHROMAX (EDS)
CLARITHROMYCIN
250MG TABLET
01984853
BIAXIN BID (EDS)
500MG TABLET
02126710
BIAXIN BID (EDS)
500MG EXTENDED-RELEASE TABLET
02244756
BIAXIN XL (EDS)
02146908
BIAXIN (EDS)
02244641
BIAXIN (EDS)
ERYTHROMYCIN BASE
250MG TABLET
00682020
APO-ERYTHRO-BASE
333MG PARTICLE COATED TABLET
00769991
PCE
250MG CAPSULE (ENTERIC COATED PELLETS)
00607142
ERYC
333MG CAPSULE (ENTERIC COATED PELLETS)
00873454
ERYC
ERYTHROMYCIN ESTOLATE
00021172
NOVO-RYTHRO ESTOLATE
00262595
7
08:12.12 ANTIBIOTICS (MACROLIDES)
ERYTHROMYCIN ETHYLSUCCINATE
00605859
00000299
NOVO-RYTHRO ETHYLSUCC.
EES 200
NOP
ABB
$
0.0671
0.0748
NOP
ABB
$
0.0899
0.1133
APX
NXP
$
0.0940
0.0940
NXP
NOP
APX
LIN
GPM
MED
$
0.0898 *
0.1120
0.1120
0.1120
0.1120
0.1120
NXP
NOP
APX
LIN
GPM
MED
$
0.1748 *
0.2181
0.2181
0.2181
0.2181
0.2181
NOP
$
0.2512
NOP
$
0.3700
00652318
00453617
EES 400
ERYTHROMYCIN STEARATE
* 250MG TABLET
00545678
02051850
APO-ERYTHRO-S
NU-ERYTHROMYCIN-S
* 250MG CAPSULE
00865567
00406724
00628115
02181487
02238171
02239761
NU-AMOXI
NOVAMOXIN
APO-AMOXI
LIN-AMOX
GEN-AMOXICILLIN
MED-AMOXICILLIN
* 500MG CAPSULE
00865575
00406716
00628123
02181495
02238172
02239762
NU-AMOXI
NOVAMOXIN
APO-AMOXI
LIN-AMOX
GEN-AMOXICILLIN
MED-AMOXICILLIN
125MG CHEWABLE TABLET
02036347
NOVAMOXIN
02036355
NOVAMOXIN
8
00865540
00452149
00628131
02181509
NU-AMOXI
NOVAMOXIN
APO-AMOXI
LIN-AMOX
NXP
NOP
APX
LIN
$
0.0174 *
0.0217
0.0217
0.0217
NXP
NOP
APX
LIN
$
0.0261 *
0.0326
0.0326
0.0326
00865559
00452130
00628158
02181517
NU-AMOXI
NOVAMOXIN
APO-AMOXI
LIN-AMOX
AMOXICILLIN TRIHYDRATE/POTASSIUM CLAVULANATE
* 250MG/125MG TABLET
02243350
02243770
01916866
APO-AMOXI CLAV (EDS)
RATIO-AMOXI CLAV (EDS)
CLAVULIN-250 (EDS)
APX
RTP
GSK
$
0.6632
0.6632
0.9943
APX
RTP
GSK
$
1.0136
1.0136
1.4915
GSK
$
2.2372
APX
RTP
GSK
$
0.0786
0.0786
0.1179
GSK
$
0.1452
APX
RTP
GSK
$
0.1322
0.1322
0.1979
GSK
$
0.2712
02243351
02243771
01916858
CLAVULIN-500 (EDS)
875MG/125MG TABLET
02238829
CLAVULIN-875 (EDS)
* 25MG/6.25MG/ML ORAL SUSPENSION
02243986
02244646
01916882
CLAVULIN-125F (EDS)
40MG/5.3MG/ML ORAL SUSPENSION
02238831
CLAVULIN-200 (EDS)
* 50MG/12.5MG/ML ORAL SUSPENSION
02243987
02244647
01916874
CLAVULIN-250F (EDS)
80MG/11.4MG/ML ORAL SUSPENSION
02238830
CLAVULIN-400 (EDS)
9
AMPICILLIN
* 250MG CAPSULE
00020877
00603279
00717657
NOVO-AMPICILLIN
APO-AMPI
NU-AMPI
NOP
APX
NXP
$
0.0889
0.0889
0.0889
NOP
APX
NXP
$
0.1723
0.1723
0.1723
APX
NXP
$
0.0174
0.0174
APX
NXP
$
0.0285
0.0285
NOP
APX
NXP
$
0.1078
0.1078
0.1078
NOP
APX
NXP
$
0.2112
0.2112
0.2112
NOP
APX
NXP
$
0.0259
0.0259
0.0259
LIH
$
0.0537
NOP
APX
NXP
LIH
$
0.0407
0.0407
0.0407
0.0407
APX
$
0.0266
* 500MG CAPSULE
00020885
00603295
00717673
NOVO-AMPICILLIN
APO-AMPI
NU-AMPI
00603260
00717495
APO-AMPI
NU-AMPI
00603287
00717649
APO-AMPI
NU-AMPI
CLOXACILLIN
* 250MG CAPSULE
00337765
00618292
00717584
NOVO-CLOXIN
APO-CLOXI
NU-CLOXI
* 500MG CAPSULE
00337773
00618284
00717592
NOVO-CLOXIN
APO-CLOXI
NU-CLOXI
* 25MG/ML ORAL LIQUID
00337757
00644633
00717630
NOVO-CLOXIN
APO-CLOXI
NU-CLOXI
PENICILLIN V (BENZATHINE)
02229617
PEN-VEE
PENICILLIN V (POTASSIUM)
* 300MG TABLET
00021202
00642215
00717568
02232391
NOVO-PEN-VK
APO-PEN-VK
NU-PEN-VK
PVF-K 500
00642223
APO-PEN-VK
10
PIVMECILLINAM HCL
200MG TABLET
00657212
SELEXID (EDS)
LEO
$
0.9203
08:12.24 ANTIBIOTICS (TETRACYCLINES)
THE USE OF TETRACYCLINES DURING TOOTH DEVELOPMENT (LAST HALF
OF PREGNANCY, INFANCY AND CHILDHOOD TO THE AGE OF 8 YEARS)
MAY CAUSE PERMANENT TOOTH DISCOLORATION (YELLOW-GRAY-BROWN).
THIS REACTION IS MORE COMMON DURING LONG-TERM USE OF
TETRACYCLINES, BUT HAS BEEN OBSERVED FOLLOWING SHORT-TERM
COURSES. ENAMEL HYPOPLASIA HAS ALSO BEEN REPORTED.
TETRACYCLINE DRUGS, THEREFORE, SHOULD NOT BE USED IN THIS
AGE GROUP UNLESS OTHER DRUGS ARE NOT LIKELY TO BE EFFECTIVE
OR ARE CONTRAINDICATED.
DOXYCYCLINE
* 100MG CAPSULE
02044668
00740713
00817120
02093103
00024368
NU-DOXYCYCLINE
APO-DOXY
DOXYCIN
RATIO-DOXYCYCLINE
VIBRAMYCIN
NXP
APX
GPM
RTP
PFI
$
0.5094 *
0.6359
0.6359
0.6359
1.8440
NXP
APX
GPM
RTP
NOP
PFI
$
0.5094 *
0.6359
0.6359
0.6359
0.6359
1.8440
* 100MG TABLET
02044676
00874256
00860751
02091232
02158574
00578452
NU-DOXYCYCLINE
APO-DOXY
DOXYCIN
RATIO-DOXYCYCLINE
NOVO-DOXYLIN
VIBRA-TABS
11
08:12.24 ANTIBIOTICS (TETRACYCLINES)
MINOCYCLINE HCL
* 50MG CAPSULE
01914138
02084090
02108143
02230735
02237313
02237875
02239238
02239667
02173514
RATIO-MINOCYCLINE (EDS)
APO-MINOCYCLINE (EDS)
NOVO-MINOCYCLINE (EDS)
GEN-MINOCYCLINE (EDS)
RHOXAL-MINOCYCLINE (EDS)
MED-MINOCYCLINE (EDS)
PMS-MINOCYCLINE (EDS)
DOM-MINOCYCLINE (EDS)
MINOCIN (EDS)
RTP
APX
NOP
GPM
RHO
MED
PMS
DOM
WYA
$
0.5805
0.5805
0.5805
0.5805
0.5805
0.5805
0.5805
0.6131
0.6456
RTP
APX
NOP
GPM
RHO
MED
PMS
DOM
WYA
$
1.1211
1.1211
1.1211
1.1211
1.1211
1.1211
1.1211
1.1769
1.2456
APX
NXP
$
0.0689
0.0689
* 100MG CAPSULE
01914146
02084104
02108151
02230736
02237314
02237876
02239239
02239668
02173506
MINOCIN (EDS)
TETRACYCLINE
* 250MG CAPSULE
00580929
00717606
APO-TETRA
NU-TETRA
08:12.28 ANTIBIOTICS (MISCELLANEOUS ANTIBIOTICS)
CLINDAMYCIN HCL
SEE NOTE REGARDING ANTIBIOTIC ASSOCIATED COLITIS OR
PSEUDOMEMBRANOUS ENTERCOLITIS UNDER SECTION 08:12.00 (ANTIBIOTICS)
* 150MG CAPSULE
02245232
02130033
02241709
00030570
APO-CLINDAMYCIN
RATIO-CLINDAMYCIN
NOVO-CLINDAMYCIN
DALACIN C
APX
RTP
NOP
PHU
$
0.5306
0.5895
0.5895
0.8896
APX
RTP
NOP
PHU
$
1.0612
1.1791
1.1791
1.7792
* 300MG CAPSULE
02245233
02192659
02241710
02182866
APO-CLINDAMYCIN
RATIO-CLINDAMYCIN
NOVO-CLINDAMYCIN
DALACIN C
12
08:12.28 ANTIBIOTICS (MISCELLANEOUS ANTIBIOTICS)
CLINDAMYCIN PALMITATE HCL
SEE NOTE REGARDING ANTIBIOTIC ASSOCIATED COLITIS OR
PSEUDOMEMBRANOUS ENTERCOLITIS UNDER SECTION 08:12.00 (ANTIBIOTICS)
00225851
DALACIN C
PHU
$
0.1197
PHU
$
72.1390
LIL
$
7.1133
LIL
$
14.2266
PMS
LIL
$
24.2000
28.4600
PMS
LIL
$
48.3700
55.4500
NXP
RTP
APX
GPM
GSK
$
LINEZOLID
600MG TABLET
02243684
ZYVOXAM (EDS)
VANCOMYCIN HCL
125MG CAPSULE
00800430
VANCOCIN (EDS)
250MG CAPSULE
00788716
VANCOCIN (EDS)
* 500MG INJECTION
02241820
00015423
PMS-VANCOMYCIN (EDS)
VANCOCIN (EDS)
* 1GM INJECTION
02241821
00722146
VANCOCIN (EDS)
08:18.00 ANTIVIRALS
ACYCLOVIR
* 200MG TABLET
02197405
02078627
02207621
02242784
00634506
NU-ACYCLOVIR
RATIO-AVIRAX
APO-ACYCLOVIR
GEN-ACYCLOVIR
ZOVIRAX
13
0.7635 *
0.9530
0.9530
0.9530
1.2706
08:18.00 ANTIVIRALS
* 400MG TABLET
02078635
02197413
02207648
02242463
01911627
RATIO-AVIRAX
NU-ACYCLOVIR
APO-ACYCLOVIR
GEN-ACYCLOVIR
ZOVIRAX WELLSTAT PAC
RTP
NXP
APX
GPM
GSK
$
1.8758
1.8758
1.8758
1.8758
2.5010
NXP
APX
GPM
RTP
GSK
$
3.0985
3.0985
3.0985
3.0986
4.9181
DOM
PMS
BMY
GPM
MED
BMY
$
0.4611 *
0.5620
0.5620
0.5620
0.5620
1.0703
BMY
PMS
DOM
$
0.0879
0.0879
0.0924
NVR
$
2.7451
NVR
$
3.6890
NVR
$
6.5534
HLR
$
4.5028
HLR
$
8.6334
GSK
$
3.2767
* 800MG TABLET
02197421
02207656
02242464
02078651
01911635
NU-ACYCLOVIR
APO-ACYCLOVIR
GEN-ACYCLOVIR
RATIO-AVIRAX
ZOVIRAX ZOSTAB PAC
AMANTADINE
* 100MG CAPSULE
02130963
01990403
02034468
02139200
02199289
01914006
DOM-AMANTADINE
PMS-AMANTADINE
ENDANTADINE
GEN-AMANTADINE
MED-AMANTADINE
SYMMETREL
* 10MG/ML SYRUP
01913999
02022826
02130971
SYMMETREL
PMS-AMANTADINE
DOM-AMANTADINE
FAMCICLOVIR
125MG TABLET
02229110
FAMVIR
250MG TABLET
02229129
FAMVIR
500MG TABLET
02177102
FAMVIR
GANCICLOVIR SO4
250MG CAPSULE
02186802
CYTOVENE (EDS)
500MG CAPSULE
02240362
CYTOVENE (EDS)
VALACYCLOVIR
500MG CAPLET
02219492
VALTREX
14
08:18.08 ANTIRETROVIRAL AGENTS (NONNUCLEOSIDE
REVERSE TRANSCRIPTASE INHIBITORS)
DELAVIRDINE MESYLATE
100MG TABLET
02238348
RESCRIPTOR (EDS)
AGR
$
0.7789
BMY
$
1.2019
BMY
$
2.4033
BMY
$
4.7634
BOE
$
5.0453
EFAVIRENZ
50MG CAPSULE
02239886
SUSTIVA (EDS)
100MG CAPSULE
02239887
SUSTIVA (EDS)
200MG CAPSULE
02239888
SUSTIVA (EDS)
NEVIRAPINE
200MG TABLET
02238748
VIRAMUNE (EDS)
08:18.08 ANTIRETROVIRAL AGENTS (NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS)
ABACAVIR SO4
300MG TABLET
02240357
ZIAGEN (EDS)
GSK
$
6.7500
GSK
$
0.4522
GSK
$
16.2500
02240358
ZIAGEN (EDS)
ABACAVIR SO4/LAMIVUDINE/ZIDOVUDINE
300MG/150MG/300MG TABLET
02244757
TRIZIVIR (EDS)
15
DIDANOSINE
SEE APPENDIX A FOR EDS CITERIA
01940511
VIDEX (EDS)
BMY
$
0.4178
BMY
$
0.8365
BMY
$
1.6728
BMY
$
2.5091
BMY
$
3.3635
BMY
$
5.3816
BMY
$
6.7270
BMY
$
10.7849
BMY
$
73.6100
GSK
$
4.7740
GSK
$
4.7740
GSK
$
0.3184
GSK
$
10.0000
01940538
VIDEX (EDS)
01940546
VIDEX (EDS)
01940554
VIDEX (EDS)
125MG CAPSULE (ENTERIC COATED BEADLET)
02244596
VIDEX EC (EDS)
02244597
VIDEX EC (EDS)
02244598
VIDEX EC (EDS)
02244599
VIDEX EC (EDS)
4G POWDER FOR ORAL SOLUTION (PACKAGE)
01940635
VIDEX (EDS)
LAMIVUDINE
100MG TABLET
02239193
HEPTOVIR (EDS)
150MG TABLET
02192683
3TC (EDS)
02192691
3TC (EDS)
LAMIVUDINE/ZIDOVUDINE
150MG/300MG TABLET
02239213
COMBIVIR (EDS)
16
STAVUDINE
15MG CAPSULE
02216086
ZERIT (EDS)
BRI
$
4.1013
BRI
$
4.2641
BRI
$
4.4485
BRI
$
4.6113
HLR
$
2.3328
APX
GSK
$
1.3020
1.8445
GSK
$
0.1962
GSK
$
17.5500
20MG CAPSULE
02216094
ZERIT (EDS)
30MG CAPSULE
02216108
ZERIT (EDS)
40MG CAPSULE
02216116
ZERIT (EDS)
ZALCITABINE
0.75MG TABLET
01990896
HIVID (EDS)
ZIDOVUDINE
* 100MG CAPSULE
01946323
01902660
APO-ZIDOVUDINE (EDS)
RETROVIR (EDS)
10MG/ML SOLUTION
01902652
RETROVIR (EDS)
10MG/ML INJECTION SOLUTION
01902644
RETROVIR (EDS)
08:18.08 ANTIRETROVIRAL AGENTS (PROTEASE INHIBITORS)
AMPRENAVIR
50MG CAPSULE
02243541
AGENERASE (EDS)
GSK
$
0.6944
GSK
$
2.0450
GSK
$
0.2084
150MG CAPSULE
02243542
AGENERASE (EDS)
02243543
AGENERASE (EDS)
17
08:18.08 ANTIRETROVIRAL AGENTS (PROTEASE INHIBITORS)
INDINAVIR SO4
200MG CAPSULE
02229161
CRIXIVAN (EDS)
MSD
$
1.4300
MSD
$
2.9224
ABB
$
3.4612
ABB
$
2.1448
AGR
$
1.9200
AGR
$
0.3951
ABB
$
1.4491
ABB
$
1.1590
HLR
$
1.9312
HLR
$
1.1067
NOP
SAW
$
0.0865
0.3481
400MG CAPSULE
02229196
CRIXIVAN (EDS)
LOPINAVIR/RITONAVIR
133.3MG/33.3MG CAPSULE
02243643
KALETRA (EDS)
80MG/20MG (ML) ORAL SOLUTION
02243644
KALETRA (EDS)
NELFINAVIR MESYLATE
250MG TABLET
02238617
VIRACEPT (EDS)
50MG/G ORAL POWDER
02238618
VIRACEPT (EDS)
RITONAVIR
100MG SOFT ELASTIC CAPSULE
02241480
NORVIR SEC (EDS)
02229145
NORVIR (EDS)
SAQUINAVIR
200MG CAPSULE
02216965
INVIRASE (EDS)
200MG SOFT GELATIN CAPSULE
02239083
FORTOVASE (EDS)
08:20.00 ANTIMALARIAL AGENTS
CHLOROQUINE PHOSPHATE
* 250MG TABLET
00021261
02017539
NOVO-CHLOROQUINE
ARALEN
18
08:20.00 ANTIMALARIAL AGENTS
HYDROXYCHLOROQUINE SO4
200MG TABLET
02017709
PLAQUENIL
SAW
$
0.5686
GSK
$
1.2882
NOP
ODN
$
0.1156
0.1156
NOP
ODN
$
0.1802
0.1802
BAY
$
2.4098
BAY
$
2.7188
BAY
$
5.1284
BAY
$
0.5438
BMY
$
5.4359
JAN
$
4.8174
JAN
$
5.4359
PYRIMETHAMINE
25MG TABLET
00004774
DARAPRIM
QUININE SO4
* 200MG CAPSULE
00021008
00695440
NOVO-QUININE
QUININE-ODAN
* 300MG CAPSULE
00021016
00695459
NOVO-QUININE
QUININE-ODAN
08:22.00 QUINOLONES
CIPROFLOXACIN
250MG TABLET
02155958
CIPRO (EDS)
500MG TABLET
02155966
CIPRO (EDS)
750MG TABLET
02155974
CIPRO (EDS)
02237514
CIPRO (EDS)
GATIFLOXACIN
400MG TABLET
02243182
TEQUIN (EDS)
LEVOFLOXACIN
250MG TABLET
02236841
LEVAQUIN (EDS)
500MG TABLET
02236842
LEVAQUIN (EDS)
19
08:22.00 QUINOLONES
MOXIFLOXACIN HCL
400MG TABLET
02242965
AVELOX (EDS)
BAY
$
5.4359
APX
NOP
MSD
$
1.6554
1.6554
2.3648
PFR
$
21.7000
PFI
$
0.1825
NOP
PGA
$
0.2470
0.3771
APX
$
0.1302
APX
$
0.1736
PGA
$
0.6700
NORFLOXACIN
* 400MG TABLET
02229524
02237682
00643025
APO-NORFLOX (EDS)
NOVO-NORFLOXACIN (EDS)
NOROXIN (EDS)
08:36.00 URINARY ANTI-INFECTIVES
METHENAMINE SALTS ARE EFFECTIVE ONLY IN ACIDIC URINE AND
ACIDIFICATION OF URINE TO PH 5.5 OR LESS IS RECOMMENDED.
FOSFOMYCIN TROMETHAMINE
3G ORAL POWDER (SACHET)
02240335
MONUROL (EDS)
METHENAMINE MANDELATE
500MG ENTERIC TABLET
00499013
MANDELAMINE
NITROFURANTOIN
* 50MG CAPSULE (MACROCRYSTALS)
02231015
01997637
NOVO-FURANTOIN
MACRODANTIN
50MG TABLET
00319511
APO-NITROFURANTOIN
100MG TABLET
00312738
APO-NITROFURANTOIN
NITROFURANTOIN MONOHYDRATE
100MG CAPSULE (MACROCRYSTALS)
02063662
MACROBID
20
08:36.00 URINARY ANTI-INFECTIVES
TRIMETHOPRIM
* 100MG TABLET
02243116
00675229
APO-TRIMETHOPRIM
PROLOPRIM
APX
GSK
$
0.2052
0.3174
APX
GSK
$
0.4216
0.6022
GSK
$
2.4199
ABB
$
0.1136
PMS
RHO
$
0.9223
0.9223
NOP
APX
$
0.0353
0.0749
NXP
GSK
APX
NOP
$
0.0420 *
0.0523
0.0523
0.0523
* 200MG TABLET
02243117
00677590
APO-TRIMETHOPRIM
PROLOPRIM
08:40.00 MISCELLANEOUS ANTI-INFECTIVES
ATOVAQUONE
150MG/ML SUSPENSION
02217422
MEPRON (EDS)
ERYTHROMYCIN ETHYLSUCCINATE/
SULFISOXAZOLE ACETATE
40MG(BASE)/120MG(BASE) PER ML ORAL SOLUTION
00583405
PEDIAZOLE
METRONIDAZOLE
* 500MG CAPSULE
00783137
01926853
TRIKACIDE
FLAGYL
* 250MG TABLET
00021555
00545066
NOVO-NIDAZOL
APO-METRONIDAZOLE
SULFAMETHOXAZOLE/TRIMETHOPRIM
(CO-TRIMOXAZOLE)
* 400MG/80MG TABLET
00865710
00270636
00445274
00510637
NU-COTRIMOX
SEPTRA
APO-SULFATRIM
NOVO-TRIMEL
21
00865729
00445282
00510645
00368040
NU-COTRIMOX DS
APO-SULFATRIM DS
NOVO-TRIMEL DS
SEPTRA D.S.
NXP
APX
NOP
GSK
$
0.1062 *
0.1325
0.1325
0.1326
APX
$
0.0955
NOP
APX
NXP
GSK
$
0.0215
0.0215
0.0215
0.0216
100MG/20MG PEDIATRIC TABLET
00445266
APO-SULFATRIM
* 40MG/8MG PER ML ORAL SUSPENSION
00726540
00846465
00865753
00270644
NOVO-TRIMEL
APO-SULFATRIM
NU-COTRIMOX
SEPTRA
22
ANTINEOPLASTIC AGENTS
10:00
10:00 ANTINEOPLASTIC AGENTS
10:00.00 ANTINEOPLASTIC AGENTS
CYPROTERONE ACETATE
* 50MG TABLET
00704431
02229723
02232872
ANDROCUR (EDS)
GEN-CYPROTERONE (EDS)
NOVO-CYPROTERONE (EDS)
PMS
GPM
NOP
$
1.6375
1.6375
1.6375
PMS
$
79.1100
HLR
$
36.8900
HLR
$
110.6700
HLR
$
221.3400
SCH
$
36.8800
SCH
$
127.2600
SCH
$
122.9400
SCH
$
221.2800
SCH
$
368.8000
SCH
$
709.8000
100MG/ML INJECTION
00704423
ANDROCUR (EDS)
INTERFERON ALFA-2A
3 MILLION IU/1ML INJECTION SOLUTION
ALBUMIN (HUMAN) FREE (1ML)
02217015
ROFERON-A (EDS)
02217058
ROFERON-A (EDS)
02217066
ROFERON-A (EDS)
INTERFERON ALFA-2B
6 MILLION IU/ML INJECTION SOLUTION
ALBUMIN (HUMAN) FREE (0.5ML)
02238674
INTRON-A (EDS)
10 MILLION IU POWDER FOR INJECTION
02223406
INTRON-A (EDS)
10 MILLION IU/ML INJECTION SOLUTION
ALBUMIN (HUMAN) FREE (0.5ML, 1ML)
02238675
INTRON-A (EDS)
18 MILLION IU/PEN MULTI-DOSE PEN (KIT)
ALBUMIN (HUMAN) FREE
02240693
INTRON-A (EDS)
02240694
INTRON-A (EDS)
02240695
INTRON-A (EDS)
24
10:00 ANTINEOPLASTIC AGENTS
10:00.00 ANTINEOPLASTIC AGENTS
MEGESTROL
* 40MG TABLET
02176092
02185415
02195917
00386391
LIN-MEGESTROL (EDS)
NU-MEGESTROL (EDS)
APO-MEGESTROL (EDS)
MEGACE (EDS)
LIN
NXP
APX
BMY
$
0.9824
0.9824
0.9824
1.4572
APX
LIN
NXP
BMY
$
3.9267
3.9350
3.9350
5.8302
BMY
$
1.1653
GSK
$
1.9899
SCH
$
425.8500
SCH
$
425.8500
SCH
$
425.8500
SCH
$
425.8500
* 160MG TABLET
02195925
02176106
02185423
00731323
APO-MEGESTROL (EDS)
LIN-MEGESTROL (EDS)
NU-MEGESTROL (EDS)
MEGACE (EDS)
02168979
MEGACE OS (EDS)
MERCAPTOPURINE
50MG TABLET
00004723
PURINETHOL (EDS)
PEGINTERFERON ALFA-2B
50UG/0.5ML POWDER FOR INJECTION (VIAL)
02242966
PEG-INTRON (EDS)
02242967
PEG-INTRON (EDS)
02242968
PEG-INTRON (EDS)
02242969
PEG-INTRON (EDS)
25
AUTONOMIC DRUGS
12:00
12:00 AUTONOMIC DRUGS
12:04.00 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
BETHANECHOL CHLORIDE
10MG TABLET
01947958
DUVOID
RBP
$
0.2512
RBP
MSD
$
0.4069
0.6847
RBP
$
0.5344
ICN
$
0.4742
ICN
$
0.4660
ICN
$
1.0196
PMS
APX
MSD
$
0.0228 *
0.0586
0.1558
MSD
$
5.1400
AVT
$
0.2013
* 25MG TABLET
01947931
00349739
DUVOID
URECHOLINE
50MG TABLET
01947923
DUVOID
NEOSTIGMINE BROMIDE
15MG TABLET
00869945
PROSTIGMIN
PYRIDOSTIGMINE BROMIDE
60MG TABLET
00869961
MESTINON
180MG LONG ACTING TABLET
00869953
MESTINON
12:08.04 ANTIPARKINSONIAN AGENTS
BENZTROPINE MESYLATE
* 2MG TABLET
00587265
00426857
00016357
PMS-BENZTROPINE
APO-BENZTROPINE
COGENTIN
00016128
COGENTIN
ETHOPROPAZINE
50MG TABLET
01927744
PARSITAN
28
12:08.04 ANTIPARKINSONIAN AGENTS
PROCYCLIDINE HCL
* 5MG TABLET
00004758
00587354
02125102
00306290
KEMADRIN
PMS-PROCYCLIDINE
DOM-PROCYCLIDINE
PROCYCLID
GSK
PMS
DOM
ICN
$
0.0277
0.0277
0.0291
0.0771
GSK
PMS
$
0.0333
0.0333
APO-TRIHEX
APX
$
0.0326
APO-TRIHEX
APX
$
0.0586
ICN
$
0.0992
AVT
$
0.2157
AVT
$
0.0612
BOE
$
0.2613
* 0.5MG/ML ELIXIR
00004405
00587362
KEMADRIN
PMS-PROCYCLIDINE
TRIHEXYPHENIDYL HCL
2MG TABLET
00545058
5MG TABLET
00545074
12:08.08 ANTIMUSCARINICS/ANTISPASMODICS
DICYCLOMINE HCL
10MG CAPSULE
00361933
FORMULEX
20MG TABLET
02103095
BENTYLOL
2MG/ML SYRUP
02102978
BENTYLOL
HYOSCINE BUTYLBROMIDE
10MG TABLET
00363812
BUSCOPAN
29
12:08.08 ANTIMUSCARINICS/ANTISPASMODICS
IPRATROPIUM BROMIDE
NOTE: WHEN USING THE INHALATION SOLUTION CARE MUST BE TAKEN
TO PREVENT CONTACT WITH EYES. A WELL FITTED NEBULIZER MASK
MUST BE USED.
INHALER AEROSOL (PACKAGE)
00576158
ATROVENT
BOE
$
17.9200
RTP
PMS
APX
BOE
$
0.8200
0.8200
0.8200
1.4301
RTP
APX
NOP
PMS
GPM
BOE
$
0.6000
0.6000
0.6000
0.6000
0.6000
0.9532
NXP
APX
RTP
GPM
PMS
BOE
$
1.3130 *
1.6384
1.6390
1.6390
1.6390
2.8610
* 0.0125% INHALATION SOLUTION (2ML)
02097176
02231135
02243827
02026759
RATIO-IPRATROPIUM UDV
PMS-IPRATROPIUM
APO-IPRAVENT
ATROVENT
* 0.025% INHALATION SOLUTION
02097141
02126222
02210479
02231136
02239131
00731439
RATIO-IPRATROPIUM
APO-IPRAVENT
NOVO-IPRAMIDE
PMS-IPRATROPIUM
GEN-IPRATROPIUM
ATROVENT
* 0.025% INHALATION SOLUTION (2ML)
02231785
02231494
02097168
02216221
02231245
01950681
NU-IPRATROPIUM
APO-IPRAVENT
GEN-IPRATROPIUM
PMS-IPRATROPIUM
ATROVENT
IPRATROPIUM BROMIDE/SALBUTAMOL SO4
NOTE: SALBUTAMOL STRENGTHS ARE EXPRESSED IN TERMS OF SALBUTAMOL
BASE EQUIVALENT.
20UG/100UG INHALER AEROSOL (PACKAGE)
02163721
COMBIVENT
BOE
$
21.0600
BOE
$
1.5930
ICN
$
0.1807
0.5MG/2.5MG INHALATION SOLUTION (2.5ML)
02231675
COMBIVENT
PROPANTHELINE BROMIDE
15MG TABLET
00294837
PROPANTHEL
12:12.00 SYMPATHOMIMETIC (ADRENERGIC) AGENTS
EPINEPHRINE
0.15MG/DOSE INJECTION SOLUTION (PACKAGE)
00578657
EPIPEN JR.
ALX
$
87.8900
ALX
$
87.8900
0.3MG/DOSE INJECTION SOLUTION (PACKAGE)
00509558
EPIPEN
30
EPINEPHRINE HCL
00155357
ADRENALIN
PFI
$
1.5700
BOE
$
10.6700
BOE
$
0.7628
BOE
$
1.5256
BOE
$
0.7628
NVR
$
0.7650
AST
$
34.4500
AST
$
45.9000
FENOTEROL HYDROBROMIDE
100UG INHALER AEROSOL (PACKAGE)
02006383
BEROTEC
0.025% INHALATION SOLUTION (2ML)
02056712
BEROTEC UDV
0.0625% INHALATION SOLUTION (2ML)
02056704
BEROTEC UDV
0.1% INHALATION SOLUTION
00541389
BEROTEC
FORMOTEROL FUMARATE
12UG/INHALATION POWDER CAPSULE
02230898
FORADIL (EDS)
6UG/DOSE POWDER FOR INHALATION (PACKAGE)
02237225
OXEZE TURBUHALER (EDS)
02237224
FORMOTEROL FUMARATE DIHYDRATE/BUDESONIDE
6UG/100UG POWDER FOR INHALATION (PACKAGE)
02245385
SYMBICORT TURBUHALER(EDS)
AST
$
65.1000
AST
$
84.6300
AMATINE (EDS)
RBP
$
0.5290
AMATINE (EDS)
RBP
$
0.8935
RTP
APX
BOE
$
0.0415
0.0415
0.0656
02245386
MIDODRINE HCL
2.5MG TABLET
01934392
5MG TABLET
01934406
ORCIPRENALINE SO4
* 2MG/ML SYRUP
02152568
02236783
00249920
RATIO-ORCIPRENALINE
APO-ORCIPRENALINE
ALUPENT
31
SALBUTAMOL SO4
NOTE: PRODUCT STRENGTHS ARE EXPRESSED IN TERMS OF SALBUTAMOL
BASE EQUIVALENT.
* 2MG TABLET
00620955
02146843
NOVO-SALMOL
APO-SALVENT
NOP
APX
$
0.0705
0.0705
NOVO-SALMOL
APO-SALVENT
NU-SALBUTAMOL
NOP
APX
NXP
$
0.1164
0.1164
0.1164
GSK
$
1.4764
GSK
$
2.0514
GSK
$
0.0738
APX
RTP
NOP
GSK
$
5.0400
5.0400
5.0400
13.3200
RTP
MDA
$
5.0400
5.0500
PMS
RTP
APX
GSK
$
0.4047
0.4047
0.4047
0.5398
$
0.5290 *
0.6603
0.6610
0.6610
0.6610
0.6610
0.7410
1.0480
* 4MG TABLET
00620963
02146851
02165376
200UG/DOSE AEROSOL POWDER DISK (8)
02214997
VENTODISK
02215004
VENTODISK
0.4MG/ML ORAL LIQUID
02212390
VENTOLIN
* 100UG/DOSE INHALER AEROSOL (PACKAGE)
00790419
00851841
00874086
02213478
⌧
APO-SALVENT
RATIO-SALBUTAMOL
NOVO-SALMOL
VENTOLIN
100UG/DOSE INHALER AEROSOL (PACKAGE)
(CFC-FREE)
02244914
02232570
RATIO-SALBUTAMOL HFA
AIROMIR
* 0.5MG/ML INHALATION SOLUTION PRESERVATIVE
FREE (2.5ML)
02208245
02239365
02243828
02022125
PMS-SALBUTAMOL
RATIO-SALBUTAMOL P.F.
APO-SALVENT
VENTOLIN NEBULES P.F.
* 1MG/ML INHALATION SOLUTION PRESERVATIVE FREE
(2.5ML)
02231783
02231488
01926934
01986864
02084333
02208229
02216949
02213419
NU-SALBUTAMOL
APO-SALVENT
GEN-SALBUTAMOL STERINEB
RATIO-SALBUTAMOL
MED-SALBUTAMOL
PMS-SALBUTAMOL
DOM-SALBUTAMOL
32
NXP
APX
GPM
RTP
MED
PMS
DOM
GSK
* 2MG/ML INHALATION SOLUTION PRESERVATIVE FREE
(2.5ML)
02173360
02208237
02231678
02231784
02239366
01945203
PMS-SALBUTAMOL
APO-SALVENT
NU-SALBUTAMOL
GPM
PMS
APX
NXP
RTP
GSK
$
1.2538
1.2538
1.2538
1.2538
1.2538
1.9905
RTP
APX
PMS
RHO
GPM
DOM
GSK
$
0.6402
0.6402
0.6402
0.6402
0.6402
0.7205
1.0167
GSK
$
54.0400
GSK
$
3.6022
GSK
$
54.0400
* 5MG/ML INHALATION SOLUTION
00860808
02046741
02069571
02154412
02232987
02139324
02213486
RATIO-SALBUTAMOL
APO-SALVENT
PMS-SALBUTAMOL RESPIR.SOL
RHOXAL-SALBUTAMOL RES.SOL
GEN-SALBUTAMOL RESPIR.SOL
DOM-SALBUTAMOL RESPIR.SOL
VENTOLIN RESPIRATOR SOLN.
SALMETEROL XINAFOATE
25UG/DOSE INHALER AEROSOL (PACKAGE)
02211742
SEREVENT (EDS)
02214261
SEREVENT (EDS)
02231129
SEREVENT DISKUS (EDS)
SALMETEROL XINAFOATE/FLUTICASONE PROPIONATE
02245126
ADVAIR (EDS)
GSK
$
93.1000
GSK
$
132.1600
$
77.8000
$
93.1000
$
132.1600
02245127
ADVAIR (EDS)
02240835
ADVAIR DISKUS (EDS)
GSK
02240836
ADVAIR DISKUS (EDS)
GSK
02240837
ADVAIR DISKUS (EDS)
33
GSK
TERBUTALINE SO4
0.5MG/DOSE POWDER FOR INHALATION (PACKAGE)
00786616
BRICANYL TURBUHALER
AST
$
15.5200
12:16.00 SYMPATHOLYTIC AGENTS (ANTIMIGRAINE DRUGS)
DIHYDROERGOTAMINE MESYLATE
02241163
00027243
DIHYDROERGOTAMINE MESYL.
DIHYDROERGOTAMINE-SANDOZ
SAB
NVR
$
3.7200
4.5800
NVR
$
9.8200
NVR
$
2.3735
PMS
$
0.8229
NVR
$
0.6961
4MG/ML NASAL SPRAY
02228947
MIGRANAL
ERGOTAMINE TARTRATE/CAFFEINE/
BELLADONNA ALKALOIDS/PENTOBARBITAL
2MG/100MG/0.25MG/60MG SUPPOSITORY
00176214
CAFERGOT-PB
FLUNARIZINE HCL
5MG CAPSULE
00846341
SIBELIUM (EDS)
METHYSERGIDE MALEATE
2MG TABLET
00027499
SANSERT (EDS)
NARATRIPTAN HCL
THE MAXIMUM QUANTITY THAT CAN BE CLAIMED THROUGH THE DRUG PLAN
IS LIMITED TO 6 DOSES PER 30 DAYS WITHIN A 60 DAY PERIOD.
SEE APPENDIX A FOR EDS CRITERIA.
1MG TABLET
02237820
AMERGE (EDS)
GSK
$
13.3350
GSK
$
14.0600
SANDOMIGRAN
NVR
$
0.3771
SANDOMIGRAN DS
NVR
$
0.6261
2.5MG TABLET
02237821
AMERGE (EDS)
PIZOTYLINE HYDROGEN MALATE
0.5MG TABLET
00329320
1MG TABLET
00511552
34
12:16.00 SYMPATHOLYTIC AGENTS (ANTIMIGRAINE DRUGS)
PROPRANOLOL
SEE SECTION 24:04.00 (CARDIAC DRUGS)
RIZATRIPTAN BENZOATE
5MG TABLET
02240520
MAXALT (EDS)
MSD
$
14.0508
MAXALT (EDS)
MSD
$
14.0508
MAXALT RPD (EDS)
MSD
$
14.0508
MSD
$
14.0508
10MG TABLET
02240521
5MG WAFER
02240518
10MG WAFER
02240519
MAXALT RPD (EDS)
SUMATRIPTAN
25MG TABLET
02239738
IMITREX (EDS)
GSK
$
13.3347
GSK
$
14.0508
GSK
$
15.4785
GSK
$
41.7400
GSK
$
13.3400
GSK
$
14.0600
50MG TABLET
02212153
IMITREX (EDS)
100MG TABLET
02212161
IMITREX (EDS)
6MG/0.5ML INJECTION SOLUTION
02212188
IMITREX (EDS)
5MG NASAL SPRAY
02230418
IMITREX (EDS)
20MG NASAL SPRAY
02230420
IMITREX (EDS)
ZOLMITRIPTAN
2.5MG TABLET
02238660
ZOMIG (EDS)
AST
$
14.0510
AST
$
14.0510
2.5MG ORALLY DISPERSIBLE TABLET
02243045
ZOMIG RAPIMELT (EDS)
35
12:20.00 SKELETAL MUSCLE RELAXANTS
BACLOFEN
* 10MG TABLET
02138271
02063735
02084449
02088398
02136090
02139332
02236507
00455881
DOM-BACLOFEN
PMS-BACLOFEN
MED-BACLOFEN
GEN-BACLOFEN
NU-BACLO
APO-BACLOFEN
RATIO-BACLOFEN
LIORESAL
DOM
PMS
MED
GPM
NXP
APX
RTP
NVR
$
0.2592 *
0.3159
0.3159
0.3159
0.3159
0.3159
0.3159
0.5014
DOM
PMS
MED
GPM
NXP
APX
RTP
NVR
$
0.5046 *
0.6149
0.6149
0.6149
0.6149
0.6149
0.6149
0.9760
NVR
$
9.8800
NVR
$
147.9400
NVR
$
147.9400
NOP
NXP
APX
PMS
GPM
RTP
MED
DOM
JAN
$
0.4085
0.4085
0.4085
0.4085
0.4085
0.4085
0.4085
0.4289
0.6159
PGA
$
0.3955
PGA
$
0.7650
* 20MG TABLET
02138298
02063743
02084457
02088401
02136104
02139391
02236508
00636576
DOM-BACLOFEN
PMS-BACLOFEN
MED-BACLOFEN
GEN-BACLOFEN
NU-BACLO
APO-BACLOFEN
RATIO-BACLOFEN
LIORESAL-DS
0.05MG/ML INJECTION (1ML)
02131048
LIORESAL INTRATHECAL(EDS)
0.5MG/ML INJECTION (20ML)
02131056
2MG/ML INJECTION (5ML)
02131064
CYCLOBENZAPRINE HCL
* 10MG TABLET
02080052
02171848
02177145
02212048
02231353
02236506
02237275
02238633
00782742
NOVO-CYCLOPRINE (EDS)
NU-CYCLOBENZAPRINE (EDS)
APO-CYCLOBENZAPRINE (EDS)
PMS-CYCLOBENZAPRINE (EDS)
GEN-CYCLOBENZAPRINE (EDS)
RTP-CYCLOBENZAPRINE (EDS)
MED-CYCLOBENZAPRINE (EDS)
DOM-CYCLOBENZAPRINE (EDS)
FLEXERIL (EDS)
DANTROLENE SODIUM
25MG CAPSULE
01997602
DANTRIUM
100MG CAPSULE
01997653
DANTRIUM
36
12:20.00 SKELETAL MUSCLE RELAXANTS
TIZANIDINE HCL
4MG TABLET
02239170
ZANAFLEX (EDS)
DPY
37
$
0.7387
BLOOD FORMATION AND COAGULATION
20:00
20:00 BLOOD FORMATION AND COAGULATION
20:04.04 IRON PREPARATIONS
IRON DEXTRAN
02221780
INFUFER (EDS)
SAB
$
28.6300
SINTROM
NVR
$
0.2685
SINTROM
NVR
$
0.8442
PHU
$
5.1600
PHU
$
16.2800
PHU
$
37.1100
PHU
$
154.6200
AVT
$
6.5600
AVT
$
21.7000
AVT
$
65.1000
ORG
$
6.0400
20:12.04 ANTICOAGULANTS
ACENOCOUMAROL
1MG TABLET
00010383
4MG TABLET
00010391
DALTEPARIN SODIUM
2,500IU SYRINGE (0.2ML)
02132621
FRAGMIN (EDS)
10,000IU/ML INJECTION SOLUTION (1ML)
02132664
FRAGMIN (EDS)
25,000IU/ML SYRINGE (0.2ML, 0.4ML, 0.5ML,
0.6ML, 0.72ML)
02132648
FRAGMIN (EDS)
25,000IU/ML INJECTION SOLUTION (3.8ML)
02231171
FRAGMIN (EDS)
ENOXAPARIN
30MG/0.3ML SYRINGE (0.3ML)
02012472
LOVENOX (EDS)
100MG/ML SYRINGE (0.4ML, 0.6ML, 0.8ML, 1ML)
02236883
LOVENOX (EDS)
02236564
LOVENOX (EDS)
HEPARIN
10,000 USP U/ML INJECTION SOLUTION (5ML)
00740497
HEPALEAN
40
NADROPARIN CALCIUM
9,500IU/ML SYRINGE (0.3ML, 0.4ML, 0.6ML,
0.8ML, 1ML)
02236913
FRAXIPARINE (EDS)
SAW
$
9.7200
SAW
$
19.4300
LEO
$
34.7200
LEO
$
7.8800
LEO
$
69.4400
INNOHEP (EDS)
LEO
$
31.2500
TARO-WARFARIN
APO-WARFARIN
GEN-WARFARIN
COUMADIN
TAR
APX
GPM
BMY
$
0.2149
0.2149
0.2149
0.3071
TARO-WARFARIN
APO-WARFARIN
GEN-WARFARIN
COUMADIN
TAR
APX
GPM
BMY
$
0.2272
0.2272
0.2272
0.3247
TARO-WARFARIN
APO-WARFARIN
GEN-WARFARIN
COUMADIN
TAR
APX
GPM
BMY
$
0.1820
0.1820
0.1820
0.2600
TARO-WARFARIN
APO-WARFARIN
COUMADIN
TAR
APX
BMY
$
0.2536
0.2536
0.4025
19,000IU/ML SYRINGE (0.6ML, 0.8ML, 1ML)
02240114
FRAXIPARINE FORTE (EDS)
TINZAPARIN SODIUM
02167840
INNOHEP (EDS)
10,000IU/ML SYRINGE (0.35ML, 0.45ML)
02229755
INNOHEP (EDS)
02229515
INNOHEP (EDS)
20,000IU/ML SYRINGE (0.5ML, 0.7ML, 0.9ML)
02231478
WARFARIN
* 1MG TABLET
02242680
02242924
02244462
01918311
* 2MG TABLET
02242681
02242925
02244463
01918338
* 2.5MG TABLET
02242682
02242926
02244464
01918346
* 3MG TABLET
02242683
02245618
02240205
41
* 4MG TABLET
02242684
02242927
02244465
02007959
TARO-WARFARIN
APO-WARFARIN
GEN-WARFARIN
COUMADIN
TAR
APX
GPM
BMY
$
0.2817
0.2817
0.2817
0.4026
TARO-WARFARIN
APO-WARFARIN
GEN-WARFARIN
COUMADIN
TAR
APX
GPM
BMY
$
0.1823
0.1823
0.1823
0.2604
TAR
APX
GPM
BMY
$
0.3271
0.3271
0.3271
0.4672
JAN
$
15.4700
JAN
$
30.9300
JAN
$
46.3900
JAN
$
61.8500
JAN
$
90.5000
JAN
$
119.0000
JAN
$
138.9500
JAN
$
290.6800
* 5MG TABLET
02242685
02242928
02244466
01918354
* 10MG TABLET
02242687
02242929
02244467
01918362
TARO-WARFARIN
APO-WARFARIN
GEN-WARFARIN
COUMADIN
20:12.20 ANTIPLATELET DRUGS
SULFINPYRAZONE
SEE SECTION 40:40:00 (URICOSURIC DRUGS)
20:16.00 HEMATOPOIETIC AGENTS
EPOETIN ALFA
1000IU/0.5ML PRE-FILLED SYRINGE
02231583
EPREX (EDS)
02231584
EPREX (EDS)
02231585
EPREX (EDS)
02231586
EPREX (EDS)
02243401
EPREX (EDS)
02243403
EPREX (EDS)
10000IU/ML PRE-FILLED SYRINGE
02231587
EPREX (EDS)
20000IU STERILE SOLUTION FOR INJECTION
02206072
EPREX (EDS)
42
20:16.00 HEMATOPOIETIC AGENTS
FILGRASTIM
300UG/ML INJECTION SOLUTION
01968017
NEUPOGEN (EDS)
AMG
$
246.5600
SAW
$
2.6057
RTP
APX
NXP
AVT
$
0.4164
0.4164
0.4164
0.6629
NXP
APX
GPM
PMS
RHO
DOM
HLR
$
0.5985 *
0.7471
0.7472
0.7472
0.7472
0.7844
1.2982
20:24.00 HEMORRHEOLOGIC AGENTS
CLOPIDOGREL BISULFATE
75MG TABLET
02238682
PLAVIX (EDS)
PENTOXIFYLLINE
* 400MG SUSTAINED RELEASE TABLET
01968432
02230090
02230401
02221977
RATIO-PENTOXIFYLLINE
APO-PENTOXIFYLLINE SR
NU-PENTOXIFYLLINE-SR
TRENTAL
TICLOPIDINE HCL
* 250MG TABLET
02237560
02237701
02239744
02243327
02243587
02243808
02162776
NU-TICLOPIDINE (EDS)
APO-TICLOPIDINE (EDS)
GEN-TICLOPIDINE (EDS)
PMS-TICLOPIDINE (EDS)
RHOXAL-TICLOPIDINE (EDS)
DOM-TICLOPIDINE (EDS)
TICLID (EDS)
43
CARDIOVASCULAR DRUGS
24:00
24:00 CARDIOVASCULAR DRUGS
24:04.00 CARDIAC DRUGS
ACEBUTOLOL HCL
* 100MG TABLET
02165546
01910140
02036290
02147602
02204517
02237721
02237885
02239754
02239758
01926543
NU-ACEBUTOLOL
RHOTRAL
MONITAN
APO-ACEBUTOLOL
NOVO-ACEBUTOLOL
GEN-ACEBUTOLOL
GEN-ACEBUTOLOL (TYPE S)
MED-ACEBUTOLOL (TYPE S)
MED-ACEBUTOLOL
SECTRAL
NXP
ROP
WYA
APX
NOP
GPM
GPM
MED
MED
AVT
$
0.1418 *
0.1769
0.1769
0.1769
0.1769
0.1769
0.1769
0.1769
0.1769
0.2949
NXP
ROP
WYA
APX
NOP
GPM
GPM
MED
MED
AVT
$
0.2122 *
0.2648
0.2648
0.2648
0.2648
0.2648
0.2648
0.2648
0.2648
0.4424
NXP
ROP
WYA
APX
NOP
GPM
GPM
MED
MED
AVT
$
0.4214 *
0.5260
0.5260
0.5260
0.5260
0.5260
0.5260
0.5260
0.5260
0.8803
* 200MG TABLET
02165554
01910159
02036436
02147610
02204525
02237722
02237886
02239755
02239759
01926551
NU-ACEBUTOLOL
RHOTRAL
MONITAN
APO-ACEBUTOLOL
NOVO-ACEBUTOLOL
GEN-ACEBUTOLOL
MED-ACEBUTOLOL
SECTRAL
* 400MG TABLET
02165562
01910167
02036444
02147629
02204533
02237723
02237887
02239756
02239760
01926578
NU-ACEBUTOLOL
RHOTRAL
MONITAN
APO-ACEBUTOLOL
NOVO-ACEBUTOLOL
GEN-ACEBUTOLOL
MED-ACEBUTOLOL
SECTRAL
AMIODARONE
AMIODARONE IS INDICATED IN TREATMENT OF SEVERE CARDIAC
ARRHYTHMIAS. THIS DRUG SHOULD ONLY BE USED UNDER THE
SUPERVISION OF A CARDIOLOGIST OR AN INTERNIST WITH EQUIVALENT
EXPERIENCE IN CARDIOLOGY.
* 200MG TABLET
02240071
02036282
RATIO-AMIODARONE
CORDARONE
46
RTP
WYA
$
1.4074
2.2339
AMLODIPINE BESYLATE
5MG TABLET
00878928
NORVASC
PFI
$
1.3888
PFI
$
2.0615
DOM
PMS
APX
NXP
NOP
GPM
RTP
MED
RHO
AST
$
0.2981 *
0.3814
0.3814
0.3814
0.3814
0.3814
0.3814
0.3814
0.3814
0.6054
DOM
APX
NXP
NOP
GPM
RTP
MED
RHO
PMS
AST
$
0.4900 *
0.6268
0.6268
0.6268
0.6268
0.6268
0.6268
0.6268
0.6268
0.9952
BVL
$
0.3798
BVL
$
0.6293
10MG TABLET
00878936
NORVASC
ATENOLOL
* 50MG TABLET
02229467
02237600
00773689
00886114
01912062
02146894
02171791
02188961
02231731
02039532
DOM-ATENOLOL
PMS-ATENOLOL
APO-ATENOL
NU-ATENOL
NOVO-ATENOL
GEN-ATENOLOL
RATIO-ATENOLOL
MED-ATENOLOL
RHOXAL-ATENOLOL
TENORMIN
* 100MG TABLET
02229468
00773697
00886122
01912054
02147432
02171805
02188988
02231733
02237601
02039540
DOM-ATENOLOL
APO-ATENOL
NU-ATENOL
NOVO-ATENOL
GEN-ATENOLOL
RATIO-ATENOLOL
MED-ATENOLOL
RHOXAL-ATENOLOL
PMS-ATENOLOL
TENORMIN
BISOPROLOL FUMARATE
5MG TABLET
02241148
MONOCOR (EDS)
10MG TABLET
02241149
MONOCOR (EDS)
CAPTOPRIL
SEE SECTION 24:08.00 (HYPOTENSIVE DRUGS)
47
CARVEDILOL
3.125MG TABLET
02229650
COREG (EDS)
GSK
$
1.3780
GSK
$
1.3780
GSK
$
1.3780
GSK
$
1.3780
VIR
$
0.2164
VIR
$
0.2164
VIR
$
0.2164
VIR
$
0.3538
NXP
APX
NOP
RTP
GPM
MED
BVL
$
0.1805 *
0.2252
0.2252
0.2252
0.2252
0.2252
0.4031
NXP
APX
NOP
RTP
GPM
MED
BVL
$
0.3161 *
0.3947
0.3947
0.3947
0.3947
0.3947
0.7070
6.25MG TABLET
02229651
COREG (EDS)
12.5MG TABLET
02229652
COREG (EDS)
25MG TABLET
02229653
COREG (EDS)
DIGOXIN
0.0625MG TABLET
02242321
LANOXIN
0.125MG TABLET
02242322
LANOXIN
0.25MG TABLET
02242323
LANOXIN
0.05MG/ML ELIXIR
02242320
LANOXIN
DILTIAZEM HCL
* 30MG TABLET
00886068
00771376
00862924
00888524
02146916
02189038
02097370
NU-DILTIAZ
APO-DILTIAZ
NOVO-DILTAZEM
RATIO-DILTIAZEM
GEN-DILTIAZEM
MED-DILTIAZEM
CARDIZEM
* 60MG TABLET
00886076
00771384
00862932
00888532
02146924
02189046
02097389
NU-DILTIAZ
APO-DILTIAZ
NOVO-DILTAZEM
RATIO-DILTIAZEM
GEN-DILTIAZEM
MED-DILTIAZEM
CARDIZEM
48
* 60MG SUSTAINED-RELEASE CAPSULE
02222957
02229406
02097214
APO-DILTIAZ SR
NOVO-DILTAZEM SR
CARDIZEM-SR
APX
NOP
BVL
$
0.3944
0.3944
0.7274
APX
NOP
BVL
$
0.5919
0.5919
0.9655
APX
NOP
BVL
$
0.7888
0.7888
1.2807
APX
NXP
NOP
RHO
RTP
BVL
$
0.8703
0.8703
0.8703
0.8703
0.8704
1.3093
BVL
$
0.8773
RTP
APX
NXP
NOP
RHO
BVL
$
1.1551
1.1551
1.1551
1.1551
1.1551
1.7380
BVL
$
1.1645
APX
NXP
NOP
RHO
RTP
BVL
$
1.5322
1.5322
1.5322
1.5322
1.5323
2.3053
BVL
$
1.5445
02222965
02229407
02097222
APO-DILTIAZ SR
NOVO-DILTAZEM SR
CARDIZEM-SR
02222973
02229408
02097230
APO-DILTIAZ SR
NOVO-DILTAZEM SR
CARDIZEM-SR
* 120MG CONTROLLED DELIVERY CAPSULE
02230997
02231052
02242538
02243338
02229781
02097249
APO-DILTIAZ CD
NU-DILTIAZ-CD
NOVO-DILTAZEM CD
RHOXAL-DILTIAZEM CD
RATIO-DILTIAZEM CD
CARDIZEM CD
120MG EXTENDED RELEASE CAPSULE
02231150
TIAZAC
02229782
02230998
02231053
02242539
02243339
02097257
RATIO-DILTIAZEM CD
APO-DILTIAZ CD
NU-DILTIAZ-CD
NOVO-DILTAZEM CD
RHOXAL-DILTIAZEM CD
CARDIZEM CD
02231151
TIAZAC
02230999
02231054
02242540
02243340
02229783
02097265
APO-DILTIAZ CD
NU-DILTIAZ-CD
NOVO-DILTAZEM CD
RHOXAL-DILTIAZEM CD
RATIO-DILTIAZEM CD
CARDIZEM CD
02231152
TIAZAC
49
02243341
02229526
02229784
02242541
02097273
RHOXAL-DILTIAZEM CD
APO-DILTIAZ CD
RATIO-DILTIAZEM CD
NOVO-DILTAZEM CD
CARDIZEM CD
RHO
APX
RTP
NOP
BVL
$
1.9102
1.9153
1.9153
1.9153
2.8816
BVL
$
1.9307
BVL
$
2.3289
AVT
$
0.2273
AVT
$
0.3212
RBP
$
0.5787
AVT
$
0.7617
MDA
$
0.5344
MDA
$
1.0688
DOM
PMS
PMS
APX
NOP
APX
NOP
NXP
GPM
GPM
MED
DOM
NVR
AST
$
0.1039 *
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1330
0.1397
0.2232
0.2442
02231154
TIAZAC
02231155
TIAZAC
DISOPYRAMIDE
100MG CAPSULE
01989553
RYTHMODAN
150MG CAPSULE
01989561
RYTHMODAN
150MG CONTROLLED RELEASE TABLET
02030810
NORPACE-CR
250MG SUSTAINED RELEASE TABLET
02224836
RYTHMODAN-LA
FLECAINIDE ACETATE
50MG TABLET
01966197
TAMBOCOR
100MG TABLET
01966200
TAMBOCOR
METOPROLOL TARTRATE
* 50MG TABLET
02172550
02145413
02230803
00618632
00648035
00749354
00842648
00865605
02174545
02230448
02239771
02231121
00397423
00402605
DOM-METOPROLOL
PMS-METOPROLOL-B
PMS-METOPROLOL-L
APO-METOPROLOL
NOVO-METOPROL
APO-METOPROLOL-TYPE L
NOVO-METOPROL (UNCOATED)
NU-METOP
GEN-METOPROLOL (TYPE L)
GEN-METOPROLOL
MED-METOPROLOL
DOM-METOPROLOL-L
LOPRESOR
BETALOC
50
* 100MG TABLET
02172569
02145421
02230804
00618640
00648043
00751170
00842656
00865613
02174553
02230449
02239772
02231122
00402540
00397431
DOM-METOPROLOL
PMS-METOPROLOL-B
PMS-METOPROLOL-L
APO-METOPROLOL
NOVO-METOPROL
NU-METOP
GEN-METOPROLOL
MED-METOPROLOL
DOM-METOPROLOL-L
BETALOC
LOPRESOR
DOM
PMS
PMS
APX
NOP
APX
NOP
NXP
GPM
GPM
MED
DOM
AST
NVR
$
0.1885 *
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2412
0.2533
0.4178
0.4579
NVR
$
0.2659
AST
NVR
$
0.4824
0.4824
NOP
$
0.3785
NOP
$
0.5068
PPZ
APX
RTP
NOP
$
0.2675
0.2675
0.2675
0.2675
PPZ
APX
RTP
NOP
$
0.3814
0.3814
0.3814
0.3814
PPZ
APX
RTP
$
0.7156
0.7156
0.7156
00658855
⌧
LOPRESOR-SR
00497827
00534560
BETALOC DURULES
LOPRESOR-SR
MEXILETINE HCL
100MG CAPSULE
02230359
NOVO-MEXILETINE
200MG CAPSULE
02230360
NOVO-MEXILETINE
NADOLOL
* 40MG TABLET
00607126
00782505
00851663
02126753
CORGARD
APO-NADOL
RATIO-NADOLOL
NOVO-NADOLOL
* 80MG TABLET
00463256
00782467
00851671
02126761
CORGARD
APO-NADOL
RATIO-NADOLOL
NOVO-NADOLOL
* 160MG TABLET
00523372
00782475
00851698
CORGARD
APO-NADOL
RATIO-NADOLOL
51
NIFEDIPINE
* 5MG CAPSULE
00725110
02047462
APO-NIFED
NOVO-NIFEDIN
APX
NOP
$
0.2648
0.2648
APX
NOP
NXP
DOM
$
0.2016
0.2016
0.2016
0.2117
APX
NXP
$
0.2436
0.2436
APX
NXP
$
0.4232
0.4232
BAY
$
0.8140
BAY
$
1.0091
ADALAT XL
BAY
$
1.5831
NU-PINDOL
APO-PINDOL
NOVO-PINDOL
GEN-PINDOLOL
MED-PINDOLOL
PMS-PINDOLOL
DOM-PINDOLOL
VISKEN
NXP
APX
NOP
GPM
MED
PMS
DOM
NVR
$
0.1985 *
0.2477
0.2477
0.2477
0.2477
0.2477
0.2601
0.4492
* 10MG CAPSULE
00755907
00756830
00865591
02236758
APO-NIFED
NOVO-NIFEDIN
NU-NIFED
DOM-NIFEDIPINE
02197448
02212102
APO-NIFED PA
NU-NIFEDIPINE-PA
02181525
02200937
APO-NIFED PA
NU-NIFEDIPINE-PA
02237618
ADALAT XL
02155907
ADALAT XL
02155990
PINDOLOL
* 5MG TABLET
00886149
00755877
00869007
02057808
02084376
02231536
02231650
00417270
52
* 10MG TABLET
00886009
00755885
00869015
02057816
02084384
02231537
02238046
00443174
NU-PINDOL
APO-PINDOL
NOVO-PINDOL
GEN-PINDOLOL
MED-PINDOLOL
PMS-PINDOLOL
DOM-PINDOLOL
VISKEN
NXP
APX
NOP
GPM
MED
PMS
DOM
NVR
$
0.3447 *
0.4302
0.4302
0.4302
0.4302
0.4302
0.4517
0.7671
APX
NOP
NXP
GPM
MED
PMS
DOM
NVR
$
0.6321
0.6321
0.6321
0.6321
0.6321
0.6321
0.6636
1.1127
APX
$
0.1913
APX
$
0.2497
APX
$
0.3321
PFI
$
0.1628
PFI
SQU
$
0.3255
0.5122
PFI
$
0.4883
APX
PMS
GPM
ABB
$
0.7395
0.7395
0.7395
0.9713
APX
PMS
GPM
ABB
$
1.3037
1.3037
1.3037
1.7121
* 15MG TABLET
00755893
00869023
00886130
02057824
02084392
02231539
02238047
00417289
APO-PINDOL
NOVO-PINDOL
NU-PINDOL
GEN-PINDOLOL
MED-PINDOLOL
PMS-PINDOLOL
DOM-PINDOLOL
VISKEN
PROCAINAMIDE HCL
250MG CAPSULE
00713325
APO-PROCAINAMIDE
375MG CAPSULE
00713333
APO-PROCAINAMIDE
500MG CAPSULE
00713341
APO-PROCAINAMIDE
00638692
⌧
PROCAN-SR
00638676
00639885
PROCAN-SR
PRONESTYL-SR
00638684
PROCAN-SR
PROPAFENONE HCL
* 150MG TABLET
02243324
02243727
02245372
00603708
APO-PROPAFENONE
PMS-PROPAFENONE
GEN-PROPAFENONE
RYTHMOL
* 300MG TABLET
02243325
02243728
02245373
00603716
APO-PROPAFENONE
PMS-PROPAFENONE
GEN-PROPAFENONE
RYTHMOL
53
PROPRANOLOL
* 10MG TABLET
02137313
00402788
00582255
00496480
02042177
DOM-PROPRANOLOL
APO-PROPRANOLOL
PMS-PROPRANOLOL
NOVO-PRANOL
INDERAL
DOM
APX
PMS
NOP
WYA
$
0.0159 *
0.0209
0.0209
0.0261
0.0748
APX
NOP
NXP
$
0.0376
0.0376
0.0376
DOM
APX
NOP
PMS
NXP
$
0.0351 *
0.0378
0.0378
0.0378
0.0378
APX
NOP
PMS
DOM
$
0.0635
0.0635
0.0635
0.0667
APX
$
0.1149
WYA
$
0.4532
WYA
$
0.5112
WYA
$
0.7870
WYA
$
0.9309
AST
$
0.4449
APX
$
0.1194
* 20MG TABLET
00663719
00740675
02044692
APO-PROPRANOLOL
NOVO-PRANOL
NU-PROPRANOLOL
* 40MG TABLET
02137321
00402753
00496499
00582263
02044706
DOM-PROPRANOLOL
APO-PROPRANOLOL
NOVO-PRANOL
PMS-PROPRANOLOL
NU-PROPRANOLOL
* 80MG TABLET
00402761
00496502
00582271
02137348
APO-PROPRANOLOL
NOVO-PRANOL
PMS-PROPRANOLOL
DOM-PROPRANOLOL
120MG TABLET
00504335
APO-PROPRANOLOL
60MG LONG ACTING CAPSULE
02042231
INDERAL-LA
02042258
INDERAL-LA
02042266
INDERAL-LA
02042274
INDERAL-LA
QUINIDINE BISULFATE
00249580
BIQUIN DURULES
QUINIDINE SO4
200MG TABLET
00441740
APO-QUINIDINE
54
SOTALOL HCL
* 80MG TABLET
02238634
00897272
02084228
02170833
02200996
02210428
02229778
02231181
02234008
02237269
02238326
DOM-SOTALOL
SOTACOR
RATIO-SOTALOL
LINSOTALOL
NU-SOTALOL
APO-SOTALOL
GEN-SOTALOL
NOVO-SOTALOL
RHOXAL-SOTALOL
MED-SOTALOL
PMS-SOTALOL
DOM
BRI
RTP
LIN
NXP
APX
GPM
NOP
RHO
MED
PMS
$
0.5282 *
0.6437
0.6437
0.6437
0.6437
0.6437
0.6437
0.6437
0.6437
0.6437
0.6437
DOM
BRI
RTP
NXP
APX
LIN
GPM
NOP
RHO
MED
PMS
$
0.5759 *
0.7044
0.7044
0.7044
0.7044
0.7044
0.7044
0.7044
0.7044
0.7044
0.7044
APX
NOP
NXP
$
0.1790
0.1790
0.1790
APX
NOP
NXP
$
0.2791
0.2791
0.2791
APX
NOP
$
0.5431
0.5431
* 160MG TABLET
02238635
00483923
02084236
02163772
02167794
02170841
02229779
02231182
02234013
02237270
02238327
DOM-SOTALOL
SOTACOR
RATIO-SOTALOL
NU-SOTALOL
APO-SOTALOL
LINSOTALOL
GEN-SOTALOL
NOVO-SOTALOL
RHOXAL-SOTALOL
MED-SOTALOL
PMS-SOTALOL
TIMOLOL MALEATE
* 5MG TABLET
00755842
01947796
02044609
APO-TIMOL
NOVO-TIMOL
NU-TIMOLOL
* 10MG TABLET
00755850
01947818
02044617
APO-TIMOL
NOVO-TIMOL
NU-TIMOLOL
* 20MG TABLET
00755869
01947826
APO-TIMOL
NOVO-TIMOL
VERAPAMIL HCL
SEE SECTION 24:08.00 (HYPOTENSIVE DRUGS)
55
24:06.00 ANTILIPEMIC DRUGS
ATORVASTATIN CALCIUM
10MG TABLET
02230711
LIPITOR
PFI
$
1.7360
PFI
$
2.1700
PFI
$
2.3328
PFI
$
2.3328
PMS
$
0.7313
HLR
$
1.7360
BRI
NOP
PMS
$
0.6952
0.6952
0.6952
PMS
BRI
NOP
$
0.6952
0.6952
0.6952
PHU
$
0.8880
COLESTID
PHU
$
0.8880
COLESTID
PHU
$
0.2533
PMS
APX
GPM
NOP
DOM
FFR
$
1.1816
1.1816
1.1816
1.1816
1.3785
1.8771
20MG TABLET
02230713
LIPITOR
40MG TABLET
02230714
LIPITOR
80MG TABLET
02243097
LIPITOR
BEZAFIBRATE
200MG TABLET
02240331
PMS-BEZAFIBRATE (EDS)
02083523
BEZALIP SR (EDS)
CHOLESTYRAMINE RESIN
* 444MG/G ORAL POWDER (9G)
00464880
02139189
02210320
QUESTRAN
NOVO-CHOLAMINE
PMS-CHOLESTYRAMINE
* 800MG/G ORAL POWDER (5G)
00890960
01918486
02139197
PMS-CHOLESTYRAMINE LIGHT
QUESTRAN LIGHT
NOVO-CHOLAMINE LIGHT
COLESTIPOL HCL RESIN
5G GRANULES
00642975
COLESTID
7.5G GRANULES
02132699
1G TABLET
02132680
FENOFIBRATE
* 200MG CAPSULE
02231780
02239864
02240210
02243552
02240337
02146959
PMS-FENOFIBR. MICRO
APO-FENO-MICRO
GEN-FENOFIBR. MICRO
NOVO-FENOFIB. MICRO
DOM-FENOFIBR. MICRO
LIPIDIL-MICRO
56
FLUVASTATIN SODIUM
20MG CAPSULE
02061562
LESCOL
NVR
$
0.8341
NVR
$
1.1677
DOM
RTP
APX
NXP
GPM
PMS
NOP
PFI
$
0.2640 *
0.3216
0.3216
0.3216
0.3216
0.3216
0.3216
0.5375
DOM
RTP
APX
NXP
NOP
PMS
GPM
MED
PFI
$
0.5421 *
0.8160
0.8160
0.8160
0.8160
0.8160
0.8160
0.8160
1.0760
APX
GPM
RTP
PMS
MSD
$
1.5028
1.5028
1.5028
1.5028
1.8786
APX
RTP
PMS
GPM
MSD
$
2.7717
2.7717
2.7717
2.7719
3.4649
40MG CAPSULE
02061570
LESCOL
GEMFIBROZIL
* 300MG CAPSULE
02241608
00851922
01979574
02058456
02185407
02239951
02241704
00599026
DOM-GEMFIBROZIL
RATIO-GEMFIBROZIL
APO-GEMFIBROZIL
NU-GEMFIBROZIL
GEN-GEMFIBROZIL
PMS-GEMFIBROZIL
NOVO-GEMFIBROZIL
LOPID
* 600MG TABLET
02230580
00851930
01979582
02058464
02142074
02230183
02230476
02237292
00659606
DOM-GEMFIBROZIL
RATIO-GEMFIBROZIL
APO-GEMFIBROZIL
NU-GEMFIBROZIL
NOVO-GEMFIBROZIL
PMS-GEMFIBROZIL
GEN-GEMFIBROZIL
MED-GEMFIBROZIL
LOPID
LOVASTATIN
* 20MG TABLET
02220172
02243127
02245822
02246013
00795860
APO-LOVASTATIN
GEN-LOVASTATIN
RATIO-LOVASTATIN
PMS-LOVASTATIN
MEVACOR
* 40MG TABLET
02220180
02245823
02246014
02243129
00795852
APO-LOVASTATIN
RATIO-LOVASTATIN
PMS-LOVASTATIN
GEN-LOVASTATIN
MEVACOR
57
PRAVASTATIN
* 10MG TABLET
02244350
02243506
02237373
02242865
00893749
NU-PRAVASTATIN
APO-PRAVASTATIN
LIN-PRAVASTATIN
BIOPRAVASTATIN
PRAVACHOL
NXP
APX
LIN
BMI
SQU
$
0.7982 *
1.0340
1.0345
1.0345
1.6421
NXP
LIN
BMI
APX
SQU
$
0.9416 *
1.2200
1.2200
1.2200
1.9368
NXP
LIN
APX
BMI
SQU
$
1.1341 *
1.4696
1.4696
1.4699
2.3328
MSD
$
0.9765
MSD
$
1.9313
MSD
$
2.3870
MSD
$
2.3870
MSD
$
2.3870
* 20MG TABLET
02244351
02237374
02242866
02243507
00893757
NU-PRAVASTATIN
LIN-PRAVASTATIN
BIOPRAVASTATIN
APO-PRAVASTATIN
PRAVACHOL
* 40MG TABLET
02244352
02237375
02243508
02242867
02222051
NU-PRAVASTATIN
LIN-PRAVASTATIN
APO-PRAVASTATIN
BIOPRAVASTATIN
PRAVACHOL
SIMVASTATIN
5MG TABLET
00884324
ZOCOR
10MG TABLET
00884332
ZOCOR
20MG TABLET
00884340
ZOCOR
40MG TABLET
00884359
ZOCOR
80MG TABLET
02240332
ZOCOR
24:08.00 HYPOTENSIVE DRUGS
ANTIHYPERTENSIVE COMBINATION PRODUCTS:
FIXED COMBINATION DRUGS ARE NOT INDICATED FOR INITIAL THERAPY
OF HYPERTENSION. HYPERTENSION REQUIRES THERAPY TO BE TITRATED
TO THE INDIVIDUAL PATIENT. IF THE FIXED COMBINATION
REPRESENTS THE DOSAGE SO DETERMINED, ITS USE MAY BE MORE
CONVENIENT IN PATIENT MANAGEMENT. THE TREATMENT OF
HYPERTENSION IS NOT STATIC, BUT MUST BE RE-EVALUATED AS
CONDITIONS IN EACH PATIENT WARRANT.
ACEBUTOLOL HCL
58
AMILORIDE HCL/HYDROCHLOROTHIAZIDE
SEE NOTE REGARDING COMBINATION PRODUCTS UNDER
SECTION 24:08.00 (HYPOTENSIVE DRUGS)
* 5MG/50MG TABLET
00886106
00784400
01937219
00487813
NU-AMILZIDE
APO-AMILZIDE
NOVAMILOR
MODURET
NXP
APX
NOP
MSD
$
0.1667 *
0.2080
0.2080
0.3816
AST
$
0.6732
AST
$
1.1033
NVR
$
0.6239
NVR
$
0.7378
NVR
$
0.8463
AST
$
1.1718
AST
$
1.1718
ATENOLOL
ATENOLOL/CHLORTHALIDONE
50MG/25MG TABLET
02049961
TENORETIC
100MG/25MG TABLET
02049988
TENORETIC
BENAZEPRIL HCL
5MG TABLET
00885835
LOTENSIN
10MG TABLET
00885843
LOTENSIN
20MG TABLET
00885851
LOTENSIN
CANDESARTAN CILEXETIL
8MG TABLET
02239091
ATACAND
16MG TABLET
02239092
ATACAND
CANDESARTAN CILEXETIL/HYDROCHLOROTHIAZIDE
16MG/12.5MG TABLET
02244021
ATACAND PLUS
AST
59
$
1.1718
CAPTOPRIL
6.25MG TABLET
01999559
APO-CAPTO
APX
$
0.1297
DOM
SQU
RTP
APX
NXP
NOP
GPM
MED
PMS
ZYP
$
0.1888 *
0.2301
0.2301
0.2301
0.2301
0.2301
0.2301
0.2301
0.2301
0.2301
DOM
SQU
RTP
APX
NXP
NOP
GPM
MED
PMS
ZYP
$
0.2672 *
0.3255
0.3255
0.3255
0.3255
0.3255
0.3255
0.3255
0.3255
0.3255
DOM
SQU
RTP
APX
NXP
NOP
GPM
MED
PMS
ZYP
$
0.4978 *
0.6066
0.6066
0.6066
0.6066
0.6066
0.6066
0.6066
0.6066
0.6066
* 12.5MG TABLET
02238551
00695661
00851639
00893595
01913824
01942964
02163551
02188929
02230203
02242788
DOM-CAPTOPRIL
CAPOTEN
RATIO-CAPTOPRIL
APO-CAPTO
NU-CAPTO
NOVO-CAPTORIL
GEN-CAPTOPRIL
MED-CAPTOPRIL
PMS-CAPTOPRIL
CAPTOPRIL
* 25MG TABLET
02238552
00546283
00851833
00893609
01913832
01942972
02163578
02188937
02230204
02242789
DOM-CAPTOPRIL
CAPOTEN
RATIO-CAPTOPRIL
APO-CAPTO
NU-CAPTO
NOVO-CAPTORIL
GEN-CAPTOPRIL
MED-CAPTOPRIL
PMS-CAPTOPRIL
CAPTOPRIL
* 50MG TABLET
02238553
00546291
00851647
00893617
01913840
01942980
02163586
02188945
02230205
02242790
DOM-CAPTOPRIL
CAPOTEN
RATIO-CAPTOPRIL
APO-CAPTO
NU-CAPTO
NOVO-CAPTORIL
GEN-CAPTOPRIL
MED-CAPTOPRIL
PMS-CAPTOPRIL
CAPTOPRIL
60
* 100MG TABLET
00546305
00851655
00893625
01913859
01942999
02163594
02188953
02230206
02242791
02238554
CAPOTEN
RATIO-CAPTOPRIL
APO-CAPTO
NU-CAPTO
NOVO-CAPTORIL
GEN-CAPTOPRIL
MED-CAPTOPRIL
PMS-CAPTOPRIL
CAPTOPRIL
DOM-CAPTOPRIL
SQU
RTP
APX
NXP
NOP
GPM
MED
PMS
ZYP
DOM
$
1.1279
1.1279
1.1279
1.1279
1.1279
1.1279
1.1279
1.1279
1.1279
1.1843
INHIBACE
HLR
$
0.6402
INHIBACE
HLR
$
0.7378
INHIBACE
HLR
$
0.8572
HLR
$
0.8572
BOE
$
0.2270
BOE
APX
NXP
NOP
$
0.1915
0.1915
0.1915
0.1915
BOE
APX
NXP
NOP
$
0.3417
0.3417
0.3417
0.3417
CILAZAPRIL
1MG TABLET
01911465
2.5MG TABLET
01911473
5MG TABLET
01911481
CILAZAPRIL/HYDROCHLOROTHIAZIDE
5MG/12.5MG TABLET
02181479
INHIBACE PLUS
CLONIDINE HCL
0.025MG TABLET
00519251
DIXARIT (EDS)
* 0.1MG TABLET
00259527
00868949
01913786
02046121
CATAPRES
APO-CLONIDINE
NU-CLONIDINE
NOVO-CLONIDINE
* 0.2MG TABLET
00291889
00868957
01913220
02046148
CATAPRES
APO-CLONIDINE
NU-CLONIDINE
NOVO-CLONIDINE
DILTIAZEM HCL
NOTE: THE SUSTAINED RELEASE DOSAGE FORMS ARE APPROVED AS
ANTIHYPERTENSIVE AGENTS
(SEE SECTION 24:04.00)
61
DOXAZOSIN MESYLATE
* 1MG TABLET
02240498
02240588
02242728
02243215
02244527
01958100
GEN-DOXAZOSIN
APO-DOXAZOSIN
NOVO-DOXAZOSIN
RATIO-DOXAZOSIN
PMS-DOXAZOSIN
CARDURA-1
GPM
APX
NOP
RTP
PMS
AST
$
0.3760
0.3760
0.3760
0.3760
0.3760
0.5968
GEN-DOXAZOSIN
APO-DOXAZOSIN
NOVO-DOXAZOSIN
RATIO-DOXAZOSIN
PMS-DOXAZOSIN
CARDURA-2
GPM
APX
NOP
RTP
PMS
AST
$
0.4512
0.4512
0.4512
0.4512
0.4512
0.7161
GEN-DOXAZOSIN
APO-DOXAZOSIN
NOVO-DOXAZOSIN
RATIO-DOXAZOSIN
PMS-DOXAZOSIN
CARDURA-4
GPM
APX
NOP
RTP
PMS
AST
$
0.5865
0.5865
0.5865
0.5865
0.5865
0.9310
VASOTEC
MSD
$
0.7327
VASOTEC
MSD
$
0.8666
MSD
$
1.0416
MSD
$
1.2568
MSD
$
0.8666
MSD
$
1.0416
* 2MG TABLET
02240499
02240589
02242729
02243216
02244528
01958097
* 4MG TABLET
02240500
02240590
02242730
02243217
02244529
01958119
ENALAPRIL MALEATE
2.5MG TABLET
00851795
5MG TABLET
00708879
10MG TABLET
00670901
VASOTEC
20MG TABLET
00670928
VASOTEC
ENALAPRIL MALEATE/HYDROCHLOROTHIAZIDE
5MG/12.5MG TABLET
02242826
VASERETIC
10MG/25MG TABLET
00657298
VASERETIC
62
EPROSARTAN MESYLATE
300MG TABLET
02240431
TEVETEN
SLV
$
0.5534
SLV
$
0.7378
SLV
$
1.1067
AVT
AST
$
0.5357
0.5360
AST
AVT
$
0.7161
0.7161
AVT
AST
$
1.0735
1.0742
BMY
$
0.8572
BMY
$
1.0308
APX
NOP
NXP
NVR
$
0.1001
0.1001
0.1001
0.1539
APX
NOP
NXP
NVR
$
0.1784
0.1784
0.1784
0.2643
APX
NOP
NXP
NVR
$
0.2742
0.2742
0.2742
0.4149
400MG TABLET
02240432
TEVETEN
600MG TABLET
02243942
TEVETEN
FELODIPINE
* 2.5MG SUSTAINED RELEASE TABLET
02221985
02057778
RENEDIL
PLENDIL
00851779
02221993
PLENDIL
RENEDIL
02222000
00851787
RENEDIL
PLENDIL
FOSINOPRIL
10MG TABLET
01907107
MONOPRIL
20MG TABLET
01907115
MONOPRIL
HYDRALAZINE HCL
* 10MG TABLET
00441619
00759465
01913204
00005525
APO-HYDRALAZINE
NOVO-HYLAZIN
NU-HYDRAL
APRESOLINE
* 25MG TABLET
00441627
00759473
02004828
00005533
APO-HYDRALAZINE
NOVO-HYLAZIN
NU-HYDRAL
APRESOLINE
* 50MG TABLET
00441635
00759481
02004836
00005541
APO-HYDRALAZINE
NOVO-HYLAZIN
NU-HYDRAL
APRESOLINE
63
IRBESARTAN
75MG TABLET
02237923
AVAPRO
BMY
$
1.1718
BMY
$
1.1718
BMY
$
1.1718
BMY
$
1.1718
BMY
$
1.1718
APX
RBP
$
0.1787
0.2553
APO-LABETALOL
TRANDATE
APX
RBP
$
0.3161
0.4515
APO-LISINOPRIL
PRINIVIL
ZESTRIL
APX
MSD
AST
$
0.6576
0.7308
0.7310
APX
MSD
AST
$
0.8246
0.8780
0.8782
APX
MSD
AST
$
0.9917
1.0551
1.0551
150MG TABLET
02237924
AVAPRO
300MG TABLET
02237925
AVAPRO
IRBESARTAN/HYDROCHLOROTHIAZIDE
150MG/12.5MG TABLET
02241818
AVALIDE
300MG/12.5MG TABLET
02241819
AVALIDE
LABETALOL HCL
* 100MG TABLET
02243538
02106272
APO-LABETALOL
TRANDATE
* 200MG TABLET
02243539
02106280
LISINOPRIL
* 5MG TABLET
02217481
00839388
02049333
* 10MG TABLET
02217503
00839396
02049376
APO-LISINOPRIL
PRINIVIL
ZESTRIL
* 20MG TABLET
02217511
00839418
02049384
APO-LISINOPRIL
PRINIVIL
ZESTRIL
64
LISINOPRIL/HYDROCHLOROTHIAZIDE
* 10MG/12.5MG TABLET
02103729
02108194
ZESTORETIC
PRINZIDE
AST
MSD
$
0.8782
0.8782
MSD
AST
$
1.0551
1.0551
MSD
AST
$
1.0551
1.0551
MSD
$
1.1940
MSD
$
1.1940
MSD
$
1.1940
MSD
$
1.1940
MSD
$
1.1940
APX
$
0.0641
APX
NXP
$
0.1519
0.1519
APX
NXP
$
0.2306
0.2306
APX
$
0.1823
APX
$
0.1991
* 20MG/12.5MG TABLET
00884413
02045737
PRINZIDE
ZESTORETIC
* 20MG/25MG TABLET
00884421
02045729
PRINZIDE
ZESTORETIC
LOSARTAN POTASSIUM
25MG TABLET
02182815
COZAAR
50MG TABLET
02182874
COZAAR
100MG TABLET
02182882
COZAAR
LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE
50MG/12.5MG TABLET
02230047
HYZAAR
100MG/25MG TABLET
02241007
HYZAAR DS
METHYLDOPA
125MG TABLET
00360252
APO-METHYLDOPA
* 250MG TABLET
00360260
00717509
APO-METHYLDOPA
NU-MEDOPA
* 500MG TABLET
00426830
00717576
APO-METHYLDOPA
NU-MEDOPA
METHYLDOPA/HYDROCHLOROTHIAZIDE
250MG/15MG TABLET
00441708
APO-METHAZIDE-15
250MG/25MG TABLET
00441716
APO-METHAZIDE-25
65
METOPROLOL TARTRATE
MINOXIDIL
2.5MG TABLET
00514497
LONITEN (EDS)
PHU
$
0.3431
PHU
$
0.7564
NVR
$
0.2804
NVR
$
0.4249
NVR
$
0.4248
NVR
$
0.8496
COVERSYL
SEV
$
0.6510
COVERSYL
SEV
$
0.8138
NVR
$
0.7513
NVR
$
0.7513
10MG TABLET
00514500
LONITEN (EDS)
NADOLOL
NIFEDIPINE
OXPRENOLOL HCL
40MG TABLET
00402575
TRASICOR
80MG TABLET
00402583
TRASICOR
80MG SLOW RELEASE TABLET
00534579
SLOW TRASICOR
160MG SLOW RELEASE TABLET
00534587
SLOW TRASICOR
PERINDOPRIL ERBUMINE
2MG TABLET
02123274
4MG TABLET
02123282
PINDOLOL
PINDOLOL/HYDROCHLOROTHIAZIDE
10MG/25MG TABLET
00568627
VISKAZIDE
10MG/50MG TABLET
00568635
VISKAZIDE
66
PRAZOSIN
* 1MG TABLET
00882801
01913794
01934198
00560952
APO-PRAZO
NU-PRAZO
NOVO-PRAZIN
MINIPRESS
APX
NXP
NOP
PFI
$
0.1683
0.1683
0.1683
0.3084
APO-PRAZO
NU-PRAZO
NOVO-PRAZIN
MINIPRESS
APX
NXP
NOP
PFI
$
0.2275
0.2275
0.2275
0.4189
APO-PRAZO
NU-PRAZO
NOVO-PRAZIN
RATIO-PRAZOSIN
MINIPRESS
APX
NXP
NOP
RTP
PFI
$
0.3284
0.3284
0.3284
0.3284
0.5757
PFI
$
0.8915
PFI
$
0.8915
PFI
$
0.8915
PFI
$
0.8915
PFI
$
0.8914
PFI
$
0.8914
* 2MG TABLET
00882828
01913808
01934201
00560960
* 5MG TABLET
00882836
01913816
01934228
02139995
00560979
PROPRANOLOL
QUINAPRIL HCL
5MG TABLET
01947664
ACCUPRIL
10MG TABLET
01947672
ACCUPRIL
20MG TABLET
01947680
ACCUPRIL
40MG TABLET
01947699
ACCUPRIL
QUINAPRIL HCL/HYDROCHLOROTHIAZIDE
10MG/12.5MG TABLET
02237367
ACCURETIC
20MG/12.5MG TABLET
02237368
ACCURETIC
67
RAMIPRIL
1.25MG CAPSULE
02221829
ALTACE
AVT
$
0.7053
AVT
$
0.8138
AVT
$
0.8138
AVT
$
1.0308
NOP
PHU
$
0.0932
0.0934
PHU
NOP
$
0.2426
0.2426
BOE
$
1.1610
BOE
$
1.1610
BOE
$
1.1610
2.5MG CAPSULE
02221837
ALTACE
5MG CAPSULE
02221845
ALTACE
10MG CAPSULE
02221853
ALTACE
SPIRONOLACTONE/HYDROCHLOROTHIAZIDE
* 25MG/25MG TABLET
00613231
00180408
NOVO-SPIROZINE
ALDACTAZIDE-25
* 50MG/50MG TABLET
00594377
00657182
ALDACTAZIDE-50
NOVO-SPIROZINE
TELMISARTAN
40MG TABLET
02240769
MICARDIS
80MG TABLET
02240770
MICARDIS
TELMISARTAN/HYDROCHLOROTHIAZIDE
80MG/12.5MG TABLET
02244344
MICARDIS PLUS
68
TERAZOSIN HCL
* 1MG TABLET
02243746
02243518
02218941
02230805
02233047
02234502
00818658
DOM-TERAZOSIN
PMS-TERAZOSIN
RATIO-TERAZOSIN
NOVO-TERAZOSIN
NU-TERAZOSIN
APO-TERAZOSIN
HYTRIN
DOM
PMS
RTP
NOP
NXP
APX
ABB
$
0.3034 *
0.3787
0.3787
0.3787
0.3787
0.3787
0.6011
DOM-TERAZOSIN
PMS-TERAZOSIN
RATIO-TERAZOSIN
NOVO-TERAZOSIN
NU-TERAZOSIN
APO-TERAZOSIN
HYTRIN
DOM
PMS
RTP
NOP
NXP
APX
ABB
$
0.3857 *
0.4813
0.4813
0.4813
0.4813
0.4813
0.7641
DOM-TERAZOSIN
PMS-TERAZOSIN
RATIO-TERAZOSIN
NOVO-TERAZOSIN
NU-TERAZOSIN
APO-TERAZOSIN
HYTRIN
DOM
PMS
RTP
NOP
NXP
APX
ABB
$
0.5238 *
0.6538
0.6538
0.6538
0.6538
0.6538
1.0377
RTP
NOP
NXP
APX
PMS
DOM
ABB
$
0.9570
0.9570
0.9570
0.9570
0.9570
1.0049
1.5190
ABB
$
24.0900
MSD
$
0.4654
* 2MG TABLET
02243747
02243519
02218968
02230806
02233048
02234503
00818682
* 5MG TABLET
02243748
02243520
02218976
02230807
02233049
02234504
00818666
* 10MG TABLET
02218984
02230808
02233050
02234505
02243521
02243749
00818674
RATIO-TERAZOSIN
NOVO-TERAZOSIN
NU-TERAZOSIN
APO-TERAZOSIN
PMS-TERAZOSIN
DOM-TERAZOSIN
HYTRIN
1MG TABLET (7) 2MG TABLET (7) 5MG TABLET (14)
(PACKAGE)
02187876
HYTRIN STARTER PACK
TIMOLOL MALEATE
TIMOLOL/HYDROCHLOROTHIAZIDE
10MG/25MG TABLET
00509353
TIMOLIDE
69
TRANDOLAPRIL
0.5MG CAPSULE
02231457
MAVIK
ABB
$
0.6727
ABB
$
0.7812
ABB
$
0.8897
NXP
APX
NOP
$
0.0416 *
0.0518
0.0518
NVR
$
1.1393
NVR
$
1.1393
NVR
$
1.1393
NVR
$
1.1393
NOP
NXP
GPM
MED
APX
ABB
$
0.2968
0.2968
0.2968
0.2968
0.3035
0.3043
APX
NOP
NXP
GPM
MED
ABB
$
0.4612
0.4612
0.4612
0.4612
0.4612
0.4728
1MG CAPSULE
02231459
MAVIK
2MG CAPSULE
02231460
MAVIK
TRIAMTERENE/HYDROCHLOROTHIAZIDE
* 50MG/25MG TABLET
00865532
00441775
00532657
NU-TRIAZIDE
APO-TRIAZIDE
NOVO-TRIAMZIDE
VALSARTAN
80MG CAPSULE
02236808
DIOVAN
160MG CAPSULE
02236809
DIOVAN
VALSARTAN/HYDROCHLOROTHIAZIDE
80MG/12.5MG TABLET
02241900
DIOVAN-HCT
160MG/12.5MG TABLET
02241901
DIOVAN-HCT
VERAPAMIL HCL
* 80MG TABLET
00812331
00886033
02237921
02239769
00782483
00554316
NOVO-VERAMIL
NU-VERAP
GEN-VERAPAMIL
MED-VERAPAMIL
APO-VERAP
ISOPTIN
* 120MG TABLET
00782491
00812358
00886041
02237922
02239770
00554324
APO-VERAP
NOVO-VERAMIL
NU-VERAP
GEN-VERAPAMIL
MED-VERAPAMIL
ISOPTIN
70
02210347
01907123
GEN-VERAPAMIL SR
ISOPTIN SR
GPM
ABB
$
0.7487
1.1038
PHU
$
0.8463
GPM
ABB
$
0.8463
1.2466
PHU
$
0.9462
DOM
GPM
NOP
PMS
ABB
$
0.7765 *
0.9462
0.9462
0.9462
1.6624
SLV
$
0.2546
SLV
$
0.4557
BOE
$
0.3008
BOE
$
0.4008
BOE
$
0.5398
BOE
$
0.8409
180MG CONTROLLED-ONSET EXTENDED-RELEASE
TABLET
02231676
CHRONOVERA
02210355
01934317
GEN-VERAPAMIL SR
ISOPTIN SR
240MG CONTROLLED-ONSET EXTENDED-RELEASE
TABLET
02231677
CHRONOVERA
02240321
02210363
02211920
02237791
00742554
DOM-VERAPAMIL SR
GEN-VERAPAMIL SR
NOVO-VERAMIL SR
PMS-VERAPAMIL SR
ISOPTIN SR
24:12.00 VASODILATING DRUGS
BETAHISTINE HCL
8MG TABLET
02240601
SERC
16MG TABLET
02243878
SERC
DIPYRIDAMOLE
25MG TABLET
00067385
PERSANTINE (EDS)
50MG TABLET
00067393
PERSANTINE (EDS)
75MG TABLET
00452092
PERSANTINE (EDS)
DIPYRIDAMOLE/ACETYLSALICYLIC ACID
200MG/25MG CAPSULE
02242119
AGGRENOX (EDS)
71
ISOSORBIDE DINITRATE
* 10MG TABLET
00441686
00458686
APO-ISDN
NOVO-SORBIDE
APX
NOP
$
0.0174
0.0174
APX
NOP
$
0.0375
0.0375
APX
$
0.0651
AST
$
0.6944
BAY
$
5.7574
* 30MG TABLET
00441694
00458694
APO-ISDN
NOVO-SORBIDE
5MG SUBLINGUAL TABLET
00670944
APO-ISDN
ISOSORBIDE-5 MONONITRATE
02126559
IMDUR
NIMODIPINE
30MG CAPSULE
02155923
NIMOTOP (EDS)
NITROGLYCERIN
NOTE: TO PREVENT DEVELOPMENT OF TOLERANCE, PATCHES SHOULD BE
REMOVED AFTER 12-14 HOURS TO PROVIDE DAILY NITRATE-FREE PERIODS
OF 10-12 HOURS. THE NITRATE-FREE PERIOD SHOULD BE TIMED TO
COINCIDE WITH THE PERIOD IN WHICH ANGINA IS LEAST LIKELY TO OCCUR
(USUALLY AT NIGHT).
⌧
0.2MG/HR. TRANSDERMAL THERAPEUTIC SYSTEM
00584223
01911910
02162806
02230732
⌧
NVR
KEY
MDA
SAW
$
0.6149
0.6149
0.6149
0.6149
NVR
KEY
MDA
SAW
$
0.6944
0.6944
0.6944
0.6944
KEY
NVR
MDA
SAW
$
0.6944
0.6944
0.6944
0.6944
00852384
01911902
02163527
02230733
⌧
TRANSDERM-NITRO 0.2
NITRO-DUR 0.2
MINITRAN 0.2
TRINIPATCH 0.2
TRANSDERM-NITRO 0.4
NITRO-DUR 0.4
MINITRAN 0.4
TRINIPATCH 0.4
01911929
02046156
02163535
02230734
NITRO-DUR 0.6
TRANSDERM-NITRO 0.6
MINITRAN 0.6
TRINIPATCH 0.6
72
02011271
NITRO-DUR 0.8
KEY
$
1.2044
PFI
$
0.0290
PFI
$
0.0302
PMS
$
0.2165
RHO
GPM
AVT
$
9.8500
10.5000
13.1200
0.3MG SUBLINGUAL TABLET
00037613
NITROSTAT
0.6MG SUBLINGUAL TABLET
00037621
NITROSTAT
2% OINTMENT
01926454
NITROL
* 0.4MG/DOSE LINGUAL SPRAY (PACKAGE)
02238998
02243588
02231441
RHO-NITRO PUMPSPRAY
GEN-NITRO SL SPRAY
NITROLINGUAL PUMPSPRAY
73
CENTRAL NERVOUS SYSTEM DRUGS
28:00
28:00 CENTRAL NERVOUS SYSTEM DRUGS
28:08.04 NON-STEROIDAL ANTI-INFLAMMATORY AGENTS
ACETYLSALICYLIC ACID
* 325MG ENTERIC TABLET
00216666
02046253
00010332
NOVASEN
MSD ENTERIC-COATED ASA
ENTROPHEN
NOP
PNG
PNG
$
0.0160
0.0160
0.0546
NOP
PNG
PNG
$
0.0382
0.0382
0.0936
PHU
$
0.6782
PHU
$
1.3563
NXP
NOP
APX
PMS
DOM
NVR
$
0.1654 *
0.2064
0.2064
0.2064
0.2293
0.3391
NXP
NOP
APX
PMS
DOM
NVR
$
0.3422 *
0.4272
0.4272
0.4272
0.4585
0.7155
NXP
APX
PMS
NOP
DOM
NVR
$
0.4960 *
0.6191
0.6191
0.6191
0.6877
1.0055
00229296
02046261
00010340
NOVASEN
ENTROPHEN
CELECOXIB
100MG CAPSULE
02239941
CELEBREX (EDS)
200MG CAPSULE
02239942
CELEBREX (EDS)
DICLOFENAC SODIUM
00886017
00808539
00839175
02231502
02231662
00514004
NU-DICLO
NOVO-DIFENAC
APO-DICLO
PMS-DICLOFENAC
DOM-DICLOFENAC
VOLTAREN
00886025
00808547
00839183
02231503
02231663
00514012
NU-DICLO
NOVO-DIFENAC
APO-DICLO
PMS-DICLOFENAC
DOM-DICLOFENAC
VOLTAREN
02228203
02162814
02231504
02158582
02231664
00782459
NU-DICLO-SR
APO-DICLO SR
PMS-DICLOFENAC-SR
NOVO-DIFENAC SR
DOM-DICLOFENAC SR
VOLTAREN-SR
76
02228211
02048698
02091194
02231505
02231665
00590827
NU-DICLO-SR
NOVO-DIFENAC SR
APO-DICLO SR
PMS-DICLOFENAC-SR
DOM-DICLOFENAC SR
VOLTAREN-SR
NXP
NOP
APX
PMS
DOM
NVR
$
0.6845 *
0.8544
0.8544
0.8544
0.9169
1.4332
NOP
PMS
SAB
NVR
$
0.6768
0.6768
0.6768
1.0742
NOP
PMS
SAB
NVR
$
0.9111
0.9111
0.9111
1.4463
PHU
$
0.6011
PHU
$
0.8181
APX
NOP
$
0.4595
0.4595
APX
NOP
NXP
$
0.5621
0.5621
0.5621
APX
$
0.6510
APX
PGA
$
0.6510
0.8680
LIL
$
0.5628
* 50MG SUPPOSITORY
02174677
02231506
02241224
00632724
NOVO-DIFENAC
PMS-DICLOFENAC
SAB-DICLOFENAC
VOLTAREN
* 100MG SUPPOSITORY
02174685
02231508
02241225
00632732
NOVO-DIFENAC
PMS-DICLOFENAC
SAB-DICLOFENAC
VOLTAREN
DICLOFENAC SODIUM/MISOPROSTOL
50MG/200UG ENTERIC TABLET
01917056
ARTHROTEC
75MG/200UG ENTERIC TABLET
02229837
ARTHROTEC 75
DIFLUNISAL
* 250MG TABLET
02039486
02048493
APO-DIFLUNISAL
NOVO-DIFLUNISAL
* 500MG TABLET
02039494
02048507
02058413
APO-DIFLUNISAL
NOVO-DIFLUNISAL
NU-DIFLUNISAL
ETODOLAC
200MG CAPSULE
02232317
APO-ETODOLAC (EDS)
* 300MG CAPSULE
02232318
02142031
APO-ETODOLAC (EDS)
ULTRADOL (EDS)
FENOPROFEN
600MG TABLET
00345504
NALFON
77
FLURBIPROFEN
* 50MG TABLET
01912046
02020661
02100509
00647942
APO-FLURBIPROFEN
NU-FLURBIPROFEN
NOVO-FLURPROFEN
ANSAID
APX
NXP
NOP
PHU
$
0.2782
0.2782
0.2782
0.5346
RTP
APX
NXP
NOP
PHU
$
0.3807
0.3807
0.3807
0.3807
0.6999
APX
NXP
NOP
MCL
$
0.0309
0.0309
0.0316
0.1696
APX
NOP
NXP
MCL
$
0.0404
0.0404
0.0404
0.2169
APX
NOP
NXP
MCL
$
0.0505
0.0505
0.0505
0.3048
NOP
APX
NXP
RTP
$
0.0945
0.0945
0.0945
0.0945
* 100MG TABLET
00675199
01912038
02020688
02100517
00600792
RATIO-FLURBIPROFEN
APO-FLURBIPROFEN
NU-FLURBIPROFEN
NOVO-FLURPROFEN
ANSAID
IBUPROFEN
* 300MG TABLET
00441651
02020696
00629332
00327794
APO-IBUPROFEN
NU-IBUPROFEN
NOVO-PROFEN
MOTRIN
* 400MG TABLET
00506052
00629340
02020718
00364142
APO-IBUPROFEN
NOVO-PROFEN
NU-IBUPROFEN
MOTRIN
* 600MG TABLET
00585114
00629359
02020726
00484911
APO-IBUPROFEN
NOVO-PROFEN
NU-IBUPROFEN
MOTRIN
INDOMETHACIN
* 25MG CAPSULE
00337420
00611158
00865850
02143364
NOVO-METHACIN
APO-INDOMETHACIN
NU-INDO
RATIO-INDOMETHACIN
78
* 50MG CAPSULE
00337439
00611166
00865869
02143372
NOVO-METHACIN
APO-INDOMETHACIN
NU-INDO
RATIO-INDOMETHACIN
NOP
APX
NXP
RTP
$
0.1640
0.1640
0.1640
0.1640
RHO
NOP
SAB
MSD
$
0.7194
0.7194
0.7194
1.1430
RHO
NOP
SAB
MSD
$
0.9668
0.9668
0.9668
1.5361
APX
PMS
AVT
$
0.1804
0.1804
0.3853
ROP
PMS
AVT
$
0.1804
0.1804
0.3853
ROP
PMS
$
0.3340
0.3340
ROP
APX
AVT
$
0.6680
0.6680
1.5864
PMS
$
0.9513
PMS
NOP
$
1.0774
1.0774
DOM
APX
PMS
NXP
PFI
$
0.2981 *
0.3590
0.3590
0.3590
0.6115
* 50MG SUPPOSITORY
02146932
02176130
02231799
00594466
RHODACINE
NOVO-METHACIN
SAB-INDOMETHACIN
INDOCID
* 100MG SUPPOSITORY
02146940
02176149
02231800
00016233
RHODACINE
NOVO-METHACIN
SAB-INDOMETHACIN
INDOCID
KETOPROFEN
* 50MG CAPSULE
00790427
02150808
01926403
APO-KETO
PMS-KETOPROFEN
ORUDIS
* 50MG ENTERIC COATED TABLET
00761672
02150816
01926381
RHODIS EC
PMS-KETOPROFEN-EC
ORUDIS-E
00761680
02150824
RHODIS EC
PMS-KETOPROFEN-EC
02031175
02172577
01926373
RHODIS SR
APO-KETOPROFEN SR
ORUDIS SR
50MG SUPPOSITORY
02148773
PMS-KETOPROFEN
* 100MG SUPPOSITORY
02015951
02156083
PMS-KETOPROFEN
NOVO-KETO
MEFENAMIC ACID
* 250MG CAPSULE
02237826
02229452
02231208
02229569
00155225
DOM-MEFENAMIC ACID
APO-MEFENAMIC
PMS-MEFENAMIC ACID
NU-MEFENAMIC
PONSTAN
79
MELOXICAM
7.5MG TABLET
02242785
MOBICOX (EDS)
BOE
$
0.8463
BOE
$
0.9765
APX
NOP
RHO
GPM
GSK
$
0.5453
0.5453
0.5453
0.5453
0.7488
NOP
GSK
$
0.7406
1.0170
APX
NXP
$
0.0590
0.0590
NXP
APX
NOP
RTP
$
0.0929 *
0.1159
0.1159
0.1159
NXP
APX
RTP
NOP
$
0.1268 *
0.1582
0.1582
0.1582
NXP
NOP
APX
RTP
$
0.1834 *
0.2290
0.2290
0.2290
APX
NOP
HLR
$
0.8251
0.8251
1.3778
15MG TABLET
02242786
MOBICOX (EDS)
NABUMETONE
* 500MG TABLET
02238639
02240867
02242912
02244563
02083531
APO-NABUMETONE (EDS)
NOVO-NABUMETONE (EDS)
RHOXAL-NABUMETONE (EDS)
GEN-NABUMETONE (EDS)
RELAFEN (EDS)
* 750MG TABLET
02240868
02083558
RELAFEN (EDS)
NAPROXEN
* 125MG TABLET
00522678
00865621
APO-NAPROXEN
NU-NAPROX
* 250MG TABLET
00865648
00522651
00565350
00615315
NU-NAPROX
APO-NAPROXEN
NOVO-NAPROX
RATIO-NAPROXEN
* 375MG TABLET
00865656
00600806
00615323
00627097
NU-NAPROX
APO-NAPROXEN
RATIO-NAPROXEN
NOVO-NAPROX
* 500MG TABLET
00865664
00589861
00592277
00615331
NU-NAPROX
NOVO-NAPROX
APO-NAPROXEN
RATIO-NAPROXEN
02177072
02231327
02162466
APO-NAPROXEN SR
NOVO-NAPROX SR
NAPROSYN-S.R.
80
* 500MG SUPPOSITORY
00756814
02230477
02017237
02162458
RATIO-NAPROXEN
NAPROXEN
PMS-NAPROXEN
NAPROSYN
RTP
SAB
PMS
HLR
$
0.8601
0.8601
0.8604
1.1935
HLR
$
0.0622
APX
$
0.0814
APX
NOP
PMS
NXP
GPM
PFI
$
0.4500
0.4500
0.4500
0.4500
0.4500
0.9952
APX
NOP
PMS
NXP
GPM
PFI
$
0.7767
0.7767
0.7767
0.7767
0.7767
1.6687
PMS
$
0.8040
PMS
PFI
$
1.1802
1.9411
MSD
$
1.3563
MSD
$
1.3563
MSD
$
0.2713
25MG/ML SUSPENSION
02162431
NAPROSYN
PHENYLBUTAZONE
100MG TABLET
00312789
APO-PHENYLBUTAZONE
PIROXICAM
* 10MG CAPSULE
00642886
00695718
00836249
00865761
02171813
00525596
APO-PIROXICAM
NOVO-PIROCAM
PMS-PIROXICAM
NU-PIROX
GEN-PIROXICAM
FELDENE
* 20MG CAPSULE
00642894
00695696
00836230
00865788
02171821
00525618
APO-PIROXICAM
NOVO-PIROCAM
PMS-PIROXICAM
NU-PIROX
GEN-PIROXICAM
FELDENE
10MG SUPPOSITORY
02154420
PMS-PIROXICAM
* 20MG SUPPOSITORY
02154463
00632716
PMS-PIROXICAM
FELDENE
ROFECOXIB
12.5MG TABLET
02241107
VIOXX (EDS)
25MG TABLET
02241108
VIOXX (EDS)
2.5MG/ML ORAL SUSPENSION
02241109
VIOXX (EDS)
81
SULINDAC
* 150MG TABLET
00745588
00778354
02042576
NOVO-SUNDAC
APO-SULIN
NU-SULINDAC
NOP
APX
NXP
$
0.4149
0.4149
0.4149
NOP
APX
NXP
$
0.5252
0.5252
0.5252
APX
NOP
PMS
RTP
$
0.3730
0.3730
0.3730
0.4055
RTP
APX
NXP
NOP
PMS
DOM
AVT
$
0.4453
0.4453
0.4453
0.4453
0.4453
0.5008
0.7069
* 200MG TABLET
00745596
00778362
02042584
NOVO-SUNDAC
APO-SULIN
NU-SULINDAC
TIAPROFENIC ACID
* 200MG TABLET
02136112
02179679
02230827
01924613
APO-TIAPROFENIC
NOVO-TIAPROFENIC
PMS-TIAPROFENIC
RATIO-TIAFEN
* 300MG TABLET
01924621
02136120
02146886
02179687
02230828
02231060
02221950
RATIO-TIAFEN
APO-TIAPROFENIC
NU-TIAPROFENIC
NOVO-TIAPROFENIC
PMS-TIAPROFENIC
DOM-TIAPROFENIC
SURGAM
28:08.08 OPIATE AGONISTS (NARCOTIC ANALGESICS)
ACETAMINOPHEN/CAFFEINE/CODEINE
* WITH 15MG CODEINE/TABLET
00653241
02163934
00687200
00293504
RATIO-LENOLTEC NO.2
TYLENOL WITH CODEINE NO.2
NOVO-GESIC C15
ATASOL-15
RTP
JAN
NOP
HOR
$
0.0537
0.0646
0.0835
0.0919
RTP
JAN
NOP
HOR
LIH
$
0.0603
0.0711
0.0867
0.1334
0.1469
* WITH 30MG CODEINE/TABLET
00653276
02163926
00687219
00293512
02232389
RATIO-LENOLTEC NO.3
NOVO-GESIC C30
ATASOL-30
EXDOL-30
82
ACETAMINOPHEN/CODEINE
300MG/30MG TABLET
00608882
RATIO-EMTEC
RTP
$
0.0494
RTP
JAN
$
0.1502
0.1502
JAN
$
0.0835
LIH
$
0.1834
PFR
$
0.3051
PFR
$
0.6102
PFR
$
0.9223
PFR
$
1.2207
RTP
$
0.0832
RTP
$
0.1080
RTP
$
0.0266
* 300MG/60MG TABLET
00621463
02163918
RATIO-LENOLTEC #4
32MG/1.6MG/ML ELIXIR
02163942
TYLENOL WITH CODEINE ELX
ACETYLSALICYLIC ACID/CAFFEINE/CODEINE
375MG/30MG/30MG TABLET
02238645
292
CODEINE
02230302
CODEINE CONTIN (EDS)
02163748
02163780
02163799
CODEINE PHOSPHATE
15MG TABLET
00593435
RATIO-CODEINE
30MG TABLET
00593451
RATIO-CODEINE
5MG/ML SYRUP
00779474
RATIO-CODEINE
83
FENTANYL
25UG/HR TRANSDERMAL SYSTEM
01937383
DURAGESIC (EDS)
JAN
$
9.2225
JAN
$
17.3600
JAN
$
24.4125
JAN
$
30.3800
DILAUDID
PMS-HYDROMORPHONE
ABB
PMS
$
0.1041
0.1041
DILAUDID
PMS-HYDROMORPHONE
ABB
PMS
$
0.1538
0.1538
DILAUDID
PMS-HYDROMORPHONE
ABB
PMS
$
0.2431
0.2431
DILAUDID
PMS-HYDROMORPHONE
ABB
PMS
$
0.3828
0.3828
PFR
$
0.6510
PFR
$
0.9765
PFR
$
1.6926
PFR
$
2.4413
PFR
$
3.1248
PFR
$
3.7433
ABB
PMS
$
0.0859
0.0860
ABB
SAB
$
1.2400
1.2400
01937391
DURAGESIC (EDS)
01937405
DURAGESIC (EDS)
01937413
DURAGESIC (EDS)
HYDROMORPHONE HCL
* 1MG TABLET
00705438
00885444
* 2MG TABLET
00125083
00885436
* 4MG TABLET
00125121
00885401
* 8MG TABLET
00786543
00885428
3MG CONTROLLED-RELEASE CAPSULE
02125323
HYDROMORPH CONTIN
6MG CONTROLLED RELEASE CAPSULE
02125331
HYDROMORPH CONTIN
02125366
HYDROMORPH CONTIN
02243562
HYDROMORPH CONTIN
02125382
HYDROMORPH CONTIN
02125390
HYDROMORPH CONTIN
00786535
01916386
DILAUDID
PMS-HYDROMORPHONE
00627100
02145901
DILAUDID
HYDROMORPHONE HCL
84
00622133
02145928
DILAUDID-HP
HYDROMORPHONE HP 10
ABB
SAB
$
3.0300
3.0300
SAB
ABB
$
4.8200
4.8200
ABB
SAB
$
10.8000
13.1500
ABB
$
76.1100
ABB
$
2.3979
SAW
$
0.1285
SAB
ABB
ABB
$
0.6900
0.8300
0.8300
SAB
ABB
ABB
$
0.7300
0.8700
0.8700
PMS
ICN
PFR
$
0.1194
0.1194
0.1194
PMS
ICN
ICN
PFR
$
0.1845
0.1845
0.1845
0.1856
PFR
ICN
$
0.3275
0.3519
PMS
ICN
$
0.2442
0.2442
02145936
02146118
HYDROMORPHONE HP 20
DILAUDID HP-PLUS
02145863
02146126
DILAUDID-XP
HYDROMORPHONE HP 50
250MG STERILE POWDER
02085895
DILAUDID
3MG SUPPOSITORY
00125105
DILAUDID
MEPERIDINE HCL
50MG TABLET
02138018
DEMEROL
00725765
00497452
02242003
MEPERIDINE HYDROCHLORIDE
PETHIDINE
DEMEROL
00725749
00497479
02242005
PETHIDINE
DEMEROL
MORPHINE
ORAL FORMS CONTAIN MORPHINE HYDROCHLORIDE OR SULFATE,
INJECTABLE FORMS CONTAIN MORPHINE SULFATE.
* 5MG TABLET
00594652
02009773
02014203
STATEX
MOS-SULFATE
MSIR
* 10MG TABLET
00594644
00690198
02009765
02014211
STATEX
M.O.S.
MOS-SULFATE
MSIR
* 20MG TABLET
02014238
00690201
MSIR
M.O.S.
* 25MG TABLET
00594636
02009749
STATEX
MOS-SULFATE
85
30MG TABLET
02014254
MSIR
PFR
$
0.4206
ICN
$
0.4573
PMS
ICN
$
0.3744
0.3744
ICN
$
0.6349
AVT
$
0.3147
AVT
$
0.3852
RTP
PMS
PFR
$
0.4523
0.4523
0.6460
ABB
$
0.8173
AVT
$
0.5859
RTP
PMS
PFR
$
0.6828
0.6828
0.9755
ICN
$
0.5953
ABB
$
1.4940
AVT
$
1.0286
RTP
PMS
PFR
$
1.2037
1.2037
1.7195
ICN
$
1.0447
ABB
$
2.6218
AVT
$
2.0724
40MG TABLET
00690228
M.O.S.
* 50MG TABLET
00675962
02009706
STATEX
MOS-SULFATE
60MG TABLET
00690244
M.O.S.
10MG EXTENDED-RELEASE CAPSULE
02019930
M-ESLON
02177749
M-ESLON
02244790
02245284
02015439
RATIO-MORPHINE SR
PMS-MORPHINE SULFATE SR
MS CONTIN
20MG SUSTAINED-RELEASE CAPSULE
02184435
KADIAN
02019949
M-ESLON
02244791
02245285
02014297
RATIO-MORPHINE SR
MS CONTIN
30MG SUSTAINED-RELEASE TABLET
00776181
M.O.S.-S.R.
02184443
KADIAN
02019957
M-ESLON
02244792
02245286
02014300
RATIO-MORPHINE SR
MS CONTIN
60MG SUSTAINED-RELEASE TABLET
00776203
M.O.S.-S.R.
02184451
KADIAN
02019965
M-ESLON
86
02014319
MS CONTIN
PFR
$
2.6218
AVT
$
4.1447
PFR
$
4.8739
ICN
PMS
RTP
$
0.0217
0.0217
0.0217
PMS
RTP
ICN
$
0.0873
0.0873
0.0914
ICN
RTP
$
0.1995
0.1995
PMS
RTP
ICN
$
0.5404
0.5404
0.5686
SAB
ABB
$
0.5600
0.6600
SAB
ABB
$
0.5600
0.6700
SAB
$
3.3700
ABB
$
96.5700
PMS
$
1.4485
PMS
PFR
$
1.6080
1.9422
PMS
PFR
$
1.9020
2.3274
02177757
M-ESLON
02014327
MS CONTIN
* 1MG/ML ORAL SOLUTION
00486582
00591467
00607762
M.O.S.
STATEX
RATIO-MORPHINE
00591475
00607770
00514217
STATEX
RATIO-MORPHINE
M.O.S.
00632503
00690783
M.O.S.
RATIO-MORPHINE
00621935
00690791
00632481
STATEX
RATIO-MORPHINE
M.O.S.
00392588
00850322
MORPHINE SO4
MORPHINE SO4
00392561
00850330
MORPHINE SO4
MORPHINE SO4
00617288
MORPHINE HP 50
50MG/ML INJECTION SOLUTION (50ML SYRINGE)
02137267
MORPHINE SULPHATE
5MG SUPPOSITORY
00632228
STATEX
* 10MG SUPPOSITORY
00632201
02014246
STATEX
MSIR
* 20MG SUPPOSITORY
00596965
02014262
STATEX
MSIR
87
* 30MG SUPPOSITORY
00639389
02014173
STATEX
MSIR
PMS
PFR
$
2.1125
2.5796
PFR
$
2.5823
PFR
$
3.2659
PFR
$
4.1773
PFR
$
6.4558
PFR
$
0.2561
PFR
$
0.3776
PFR
$
0.6554
PFR
$
0.8680
PFR
$
1.3020
PFR
$
2.2568
PFR
$
4.1664
30MG SUSTAINED RELEASE SUPPOSITORY
02146827
MS CONTIN
02145944
MS CONTIN
02145952
MS CONTIN
02145960
MS CONTIN
OXYCODONE HCL
5MG IMMEDIATE RELEASE TABLET
02231934
OXY-IR
02240131
OXY-IR
02240132
OXY-IR
02202441
OXYCONTIN
02202468
OXYCONTIN
02202476
OXYCONTIN
02202484
OXYCONTIN
PROPOXYPHENE
SEVERE TOXIC INTERACTION BETWEEN PROPOXYPHENE AND CENTRAL
NERVOUS SYSTEM DEPRESSANTS, PARTICULARLY ALCOHOL AND DIAZEPAM,
HAS BEEN NOTED. IT IS RECOMMENDED THAT ALL PRODUCTS WHICH
CONTAIN PROPOXYPHENE SHOULD BE USED ONLY WITH EXTREME CAUTION
AND WITH FULL PATIENT AWARENESS OF THE SERIOUS POTENTIAL FOR
INTERACTION.
PROPOXYPHENE NAPSYLATE 100MG IS EQUIVALENT IN ANALGESIC
ACTIVITY TO PROPOXYPHENE HCL 65MG.
CAPSULE
00261432
DARVON-N
LIL
$
0.2332
LIH
$
0.1155
65MG TABLET
00010081
642
88
28:08.12 OPIATE PARTIAL AGONISTS
PENTAZOCINE
50MG TABLET
02137984
TALWIN
SAW
$
0.3708
28:08.92 MISCELLANEOUS ANALGESICS AND ANTIPYRETICS
FLOCTAFENINE
* 200MG TABLET
02244680
02017628
APO-FLOCTAFENINE
IDARAC
APX
SAW
$
0.3151
0.3939
APX
SAW
$
0.5487
0.6859
PMS
$
0.0651
PMS
$
0.0775
PMS
$
0.1050
PMS
$
0.1437
PMS
$
0.0868
APX
$
0.0516
APX
DPY
$
0.0814
0.1222
* 400MG TABLET
02244681
02017636
APO-FLOCTAFENINE
IDARAC
28:12.04 ANTICONVULSANTS (BARBITURATES)
PHENOBARBITAL
15MG TABLET
00178799
PMS-PHENOBARBITAL
30MG TABLET
00178802
PMS-PHENOBARBITAL
60MG TABLET
00178810
PMS-PHENOBARBITAL
100MG TABLET
00178829
PMS-PHENOBARBITAL
5MG/ML ELIXIR
00645575
PMS-PHENOBARBITAL
PRIMIDONE
125MG TABLET
00399310
APO-PRIMIDONE
* 250MG TABLET
00396761
02042355
APO-PRIMIDONE
MYSOLINE
89
28:12.08 ANTICONVULSANTS (BENZODIAZEPINES)
CLONAZEPAM
* 0.5MG TABLET
02130998
02224100
02103656
02173344
02177889
02207818
02230366
02230950
02233960
02237277
02239024
00382825
DOM-CLONAZEPAM
DOM-CLONAZEPAM-R
RATIO-CLONAZEPAM
NU-CLONAZEPAM
APO-CLONAZEPAM
PMS-CLONAZEPAM-R
CLONAPAM
GEN-CLONAZEPAM
RHOXAL-CLONAZEPAM
MED-CLONAZEPAM
NOVO-CLONAZEPAM
RIVOTRIL
DOM
DOM
RTP
NXP
APX
PMS
ICN
GPM
RHO
MED
NOP
HLR
$
0.0854 *
0.0854 *
0.1266
0.1266
0.1266
0.1266
0.1266
0.1266
0.1266
0.1266
0.1266
0.2008
PMS-CLONAZEPAM
CLONAPAM
RHOXAL-CLONAZEPAM
PMS
ICN
RHO
$
0.2019
0.2019
0.2019
DOM-CLONAZEPAM
PMS-CLONAZEPAM
RATIO-CLONAZEPAM
NU-CLONAZEPAM
APO-CLONAZEPAM
CLONAPAM
GEN-CLONAZEPAM
RHOXAL-CLONAZEPAM
MED-CLONAZEPAM
NOVO-CLONAZEPAM
RIVOTRIL
DOM
PMS
RTP
NXP
APX
ICN
GPM
RHO
MED
NOP
HLR
$
0.1790 *
0.2181
0.2181
0.2181
0.2181
0.2181
0.2181
0.2181
0.2181
0.2181
0.3462
ICN
RHO
ICN
$
0.0996
0.0996
0.1476
ICN
RHO
ICN
$
0.1490
0.1490
0.2208
* 1MG TABLET
02048728
02230368
02233982
* 2MG TABLET
02131013
02048736
02103737
02173352
02177897
02230369
02230951
02233985
02237278
02239025
00382841
NITRAZEPAM
* 5MG TABLET
02229654
02234003
00511528
NITRAZADON
RHOXAL-NITRAZEPAM
MOGADON
* 10MG TABLET
02229655
02234007
00511536
NITRAZADON
RHOXAL-NITRAZEPAM
MOGADON
90
28:12.12 ANTICONVULSANTS (HYDANTOINS)
PHENYTOIN
30MG CAPSULE
00022772
DILANTIN
PFI
$
0.0540
PFI
$
0.0674
PFI
$
0.0740
PFI
$
0.0408
PFI
$
0.0482
PFI
$
0.3051
PFI
$
0.0610
PFI
$
0.3375
$
0.0929
0.1327
100MG CAPSULE
00022780
DILANTIN
50MG TABLET
00023698
DILANTIN
00023442
DILANTIN
00023450
DILANTIN
28:12.20 ANTICONVULSANTS (SUCCINIMIDES)
ETHOSUXIMIDE
250MG CAPSULE
00022799
ZARONTIN
50MG/ML ORAL SYRUP
00023485
ZARONTIN
METHSUXIMIDE
300MG CAPSULE
00022802
CELONTIN
28:12.92 MISCELLANEOUS ANTICONVULSANTS
CARBAMAZEPINE
* 100MG CHEWABLE TABLET
02244403
00369810
TARO-CARBAMAZEPINE
TEGRETOL
91
TAR
NVR
* 200MG TABLET
02042568
00402699
00782718
00010405
NU-CARBAMAZEPINE
APO-CARBAMAZEPINE
NOVO-CARBAMAZ
TEGRETOL
NXP
APX
NOP
NVR
$
0.0692 *
0.0863
0.0863
0.3164
PMS
TAR
GPM
APX
DOM
NVR
$
0.2048
0.2048
0.2048
0.2048
0.2560
0.3251
PMS
GPM
APX
TAR
DOM
NVR
$
0.4095
0.4095
0.4095
0.4096
0.5121
0.6502
NVR
$
0.0628
NOP
RTP
APX
AVT
$
0.2598
0.2598
0.2598
0.3708
NXP
APX
NOP
PMS
DOM
ABB
$
0.1660
0.1660
0.1660
0.1660
0.1744
0.2372
NXP
APX
NOP
PMS
DOM
ABB
$
0.2984
0.2984
0.2984
0.2984
0.3134
0.4262
* 200MG CONTROLLED RELEASE TABLET
02231543
02237907
02241882
02242908
02238222
00773611
PMS-CARBAMAZEPINE CR(EDS)
TARO-CARBAMAZEPINE (EDS)
GEN-CARBAMAZEPINE CR(EDS)
APO-CARBAMAZEPINE CR(EDS)
DOM-CARBAMAZEPINE CR(EDS)
TEGRETOL CR (EDS)
* 400MG CONTROLLED RELEASE TABLET
02231544
02241883
02242909
02237908
02238223
00755583
TEGRETOL CR (EDS)
02194333
TEGRETOL
CLOBAZAM
* 10MG TABLET
02238334
02238797
02244638
02221799
NOVO-CLOBAZAM
RATIO-CLOBAZAM
APO-CLOBAZAM
FRISIUM
DIVALPROEX SODIUM
02239517
02239698
02239701
02244138
02245751
00596418
NU-DIVALPROEX
APO-DIVALPROEX
NOVO-DIVALPROEX
PMS-DIVALPROEX
DOM-DIVALPROEX
EPIVAL
02239518
02239699
02239702
02244139
02245752
00596426
NU-DIVALPROEX
APO-DIVALPROEX
NOVO-DIVALPROEX
PMS-DIVALPROEX
DOM-DIVALPOREX
EPIVAL
92
02239519
02239700
02239703
02244140
02245753
00596434
NU-DIVALPROEX
APO-DIVALPROEX
NOVO-DIVALPROEX
PMS-DIVALPROEX
DOM-DIVALPROEX
EPIVAL
NXP
APX
NOP
PMS
DOM
ABB
$
0.5971
0.5971
0.5971
0.5971
0.6270
0.8530
PMS
APX
NOP
DOM
PFI
$
0.3038
0.3038
0.3038
0.3190
0.4340
PMS
APX
NOP
DOM
PFI
$
0.7390
0.7390
0.7390
0.7760
1.0557
PMS
APX
NOP
DOM
PFI
$
0.8807
0.8807
0.8807
0.9248
1.2581
GSK
$
0.1551
APX
GSK
$
0.2519
0.3597
APX
GSK
$
1.0071
1.4388
APX
GSK
$
1.5107
2.1581
GABAPENTIN
* 100MG CAPSULE
02243446
02244304
02244513
02243743
02084260
PMS-GABAPENTIN
APO-GABAPENTIN
NOVO-GABAPENTIN
DOM-GABAPENTIN
NEURONTIN
* 300MG CAPSULE
02243447
02244305
02244514
02243744
02084279
PMS-GABAPENTIN
APO-GABAPENTIN
NOVO-GABAPENTIN
DOM-GABAPENTIN
NEURONTIN
* 400MG CAPSULE
02243448
02244306
02244515
02243745
02084287
PMS-GABAPENTIN
APO-GABAPENTIN
NOVO-GABAPENTIN
DOM-GABAPENTIN
NEURONTIN
LAMOTRIGINE
5MG CHEWABLE TABLET
02240115
LAMICTAL
* 25MG TABLET
02245208
02142082
APO-LAMOTRIGINE
LAMICTAL
* 100MG TABLET
02245209
02142104
APO-LAMOTRIGINE
LAMICTAL
* 150MG TABLET
02245210
02142112
APO-LAMOTRIGINE
LAMICTAL
93
TOPIRAMATE
25MG TABLET
02230893
TOPAMAX
JAN
$
1.1393
JAN
$
2.1592
JAN
$
3.4178
JAN
$
1.0850
JAN
$
1.1393
DOM
RTP
PMS
RTP
APX
ABB
$
0.0595
0.0626
0.0626
0.0626
0.0628
0.0995
DOM
NOP
RTP
GPM
MED
PMS
NXP
APX
RHO
ABB
$
0.2328 *
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.4475
RTP
NOP
PMS
RHO
ABB
$
0.5639
0.5639
0.5639
0.5639
0.8951
100MG TABLET
02230894
TOPAMAX
200MG TABLET
02230896
TOPAMAX
15MG SPRINKLE CAPSULE
02239907
TOPAMAX
25MG SPRINKLE CAPSULE
02239908
TOPAMAX
VALPROATE SODIUM
* 50MG/ML ORAL SYRUP
02238817
02140063
02236807
02238042
02238370
00443832
DOM-VALPROIC ACID
RATIO-VALPROIC
PMS-VALPROIC ACID
RATIO-DEPROIC
APO-VALPROIC
DEPAKENE
VALPROIC ACID
* 250MG CAPSULE
02231030
02100630
02140047
02184648
02230663
02230768
02237830
02238048
02239714
00443840
DOM-VALPROIC ACID
NOVO-VALPROIC
RATIO-VALPROIC
GEN-VALPROIC
MED-VALPROIC
PMS-VALPROIC
NU-VALPROIC
APO-VALPROIC
RHOXAL-VALPROIC
DEPAKENE
* 500MG ENTERIC COATED CAPSULE
02140055
02218321
02229628
02239713
00507989
RATIO-VALPROIC
NOVO-VALPROIC
PMS-VALPROIC ACID E.C.
RHOXAL-VALPROIC
DEPAKENE
94
VIGABATRIN
500MG TABLET
02065819
SABRIL
AVT
$
0.9624
AVT
$
0.9624
500MG SACHET
02068036
SABRIL
28:16.04 PSYCHOTHERAPEUTIC AGENTS (ANTIDEPRESSANTS)
PHENELZINE AND TRANYLCYPROMINE:
MONOAMINE OXIDASE INHIBITORS INTERACT WITH SYMPATHOMIMETIC
DRUGS, FOODS AND ALCOHOLIC BEVERAGES CONTAINING TYRAMINE OR
OTHER PRESSOR AMINES (EG. CHEESE, HERRING, CHICKEN LIVERS,
BROAD BEANS, CHIANTI WINE, ETC.) AND MAY EVOKE HYPERTENSION.
THESE DRUGS ARE CONTRAINDICATED IN PATIENTS WITH
CEREBROVASCULAR AND CARDIOVASCULAR DISEASE. THE MANUFACTURERS'
LITERATURE REGARDING PRECAUTIONS AND CONTRAINDICATIONS
SHOULD BE CONSULTED PRIOR TO PRESCRIBING THESE DRUGS.
AMITRIPTYLINE
* 10MG TABLET
00335053
00016322
APO-AMITRIPTYLINE
ELAVIL
APX
MSD
$
0.0565
0.0787
APX
MSD
$
0.1080
0.1500
APX
MSD
$
0.2008
0.2785
GSK
$
0.5788
GSK
$
0.8680
LUD
$
1.3563
LUD
$
1.3563
* 25MG TABLET
00335061
00016330
APO-AMITRIPTYLINE
ELAVIL
* 50MG TABLET
00335088
00016349
APO-AMITRIPTYLINE
ELAVIL
BUPROPION HCL
100MG TABLET
02237824
WELLBUTRIN SR (EDS)
150MG TABLET
02237825
WELLBUTRIN SR (EDS)
CITALOPRAM HYDROBROMIDE
20MG TABLET
02239607
CELEXA
40MG TABLET
02239608
CELEXA
95
CLOMIPRAMINE HCL
* 10MG TABLET
02040786
02139340
02188996
02230256
00330566
APO-CLOMIPRAMINE
GEN-CLOMIPRAMINE
MED-CLOMIPRAMINE
NOVO-CLOPAMINE
ANAFRANIL
APX
GPM
MED
NOP
NVR
$
0.1765
0.1765
0.1765
0.1765
0.2801
APX
NOP
GPM
MED
NVR
$
0.2404
0.2404
0.2404
0.2404
0.3815
APX
NOP
GPM
MED
NVR
$
0.4425
0.4425
0.4425
0.4425
0.7025
PMS
NXP
APX
NOP
DOM
$
0.2067
0.2067
0.2067
0.2067
0.2395
DOM
PMS
RTP
NXP
APX
NOP
AVT
$
0.2266 *
0.2761
0.2761
0.2761
0.2761
0.2761
0.3752
* 25MG TABLET
02040778
02130165
02139359
02189003
00324019
APO-CLOMIPRAMINE
NOVO-CLOPAMINE
GEN-CLOMIPRAMINE
MED-CLOMIPRAMINE
ANAFRANIL
* 50MG TABLET
02040751
02130173
02139367
02189011
00402591
APO-CLOMIPRAMINE
NOVO-CLOPAMINE
GEN-CLOMIPRAMINE
MED-CLOMIPRAMINE
ANAFRANIL
DESIPRAMINE HCL
* 10MG TABLET
01946250
02211939
02216248
02223341
02130084
PMS-DESIPRAMINE
NU-DESIPRAMINE
APO-DESIPRAMINE
NOVO-DESIPRAMINE
DOM-DESIPRAMINE
* 25MG TABLET
02130092
01946269
01948784
02211947
02216256
02223325
02099128
DOM-DESIPRAMINE
PMS-DESIPRAMINE
RATIO-DESIPRAMINE
NU-DESIPRAMINE
APO-DESIPRAMINE
NOVO-DESIPRAMINE
NORPRAMIN
96
* 50MG TABLET
02130106
01946277
01948792
02211955
02216264
02223333
02099136
DOM-DESIPRAMINE
PMS-DESIPRAMINE
RATIO-DESIPRAMINE
NU-DESIPRAMINE
APO-DESIPRAMINE
NOVO-DESIPRAMINE
NORPRAMIN
DOM
PMS
RTP
NXP
APX
NOP
AVT
$
0.3660 *
0.4460
0.4460
0.4460
0.4460
0.4460
0.6615
PMS
RTP
NXP
APX
NOP
$
0.6873
0.6873
0.6873
0.6873
0.6873
NXP
APX
$
0.9342
0.9342
APX
PFI
$
0.1286
0.2696
NOP
APX
PFI
$
0.1552
0.1552
0.3306
NOP
APX
PFI
$
0.2418
0.2418
0.6134
NOP
APX
RTP
PFI
$
0.5180
0.5180
0.5180
0.8806
NOP
APX
PFI
$
0.6803
0.6803
1.1601
NOP
APX
$
1.0280
1.0280
* 75MG TABLET
01946242
01948806
02211963
02216272
02223368
PMS-DESIPRAMINE
RATIO-DESIPRAMINE
NU-DESIPRAMINE
APO-DESIPRAMINE
NOVO-DESIPRAMINE
* 100MG TABLET
02211971
02216280
NU-DESIPRAMINE
APO-DESIPRAMINE
DOXEPIN HCL
* 10MG CAPSULE
02049996
00024325
APO-DOXEPIN
SINEQUAN
* 25MG CAPSULE
01913425
02050005
00024333
NOVO-DOXEPIN
APO-DOXEPIN
SINEQUAN
* 50MG CAPSULE
01913433
02050013
00024341
NOVO-DOXEPIN
APO-DOXEPIN
SINEQUAN
* 75MG CAPSULE
01913441
02050021
02140128
00400750
NOVO-DOXEPIN
APO-DOXEPIN
RATIO-DOXEPIN
SINEQUAN
* 100MG CAPSULE
01913468
02050048
00326925
NOVO-DOXEPIN
APO-DOXEPIN
SINEQUAN
* 150MG CAPSULE
01913476
02050056
NOVO-DOXEPIN
APO-DOXEPIN
97
FLUOXETINE
* 10MG CAPSULE
02177617
02177579
02192756
02216353
02216582
02237813
02239751
02241371
02242177
02243486
02018985
DOM-FLUOXETINE
PMS-FLUOXETINE
NU-FLUOXETINE
APO-FLUOXETINE
NOVO-FLUOXETINE
GEN-FLUOXETINE
MED FLUOXETINE
RATIO-FLUOXETINE
CO FLUOXETINE
RHOXAL-FLUOXETINE
PROZAC
DOM
PMS
NXP
APX
NOP
GPM
MED
RTP
COB
RHO
LIL
$
1.0234 *
1.2774
1.2774
1.2774
1.2774
1.2774
1.2774
1.2774
1.2774
1.2774
1.7035
NXP
PMS
APX
NOP
GPM
MED
RTP
COB
RHO
DOM
LIL
$
0.8162 *
1.0972
1.0972
1.0972
1.0972
1.0972
1.0972
1.0972
1.0972
1.4802
1.7415
PMS
APX
LIL
$
0.5019
0.5019
0.6692
NXP
RTP
APX
NOP
PMS
DOM
SLV
$
0.4305 *
0.5373
0.5373
0.5373
0.5373
0.5641
0.8529
* 20MG CAPSULE
02192764
02177587
02216361
02216590
02237814
02239752
02241374
02242178
02243487
02177625
00636622
NU-FLUOXETINE
PMS-FLUOXETINE
APO-FLUOXETINE
NOVO-FLUOXETINE
GEN-FLUOXETINE
MED FLUOXETINE
RATIO-FLUOXETINE
CO FLUOXETINE
RHOXAL-FLUOXETINE
DOM-FLUOXETINE
PROZAC
02177595
02231328
01917021
PMS-FLUOXETINE
APO-FLUOXETINE
PROZAC
FLUVOXAMINE MALEATE
* 50MG TABLET
02231192
02218453
02231329
02239953
02240682
02241347
01919342
NU-FLUVOXAMINE
RATIO-FLUVOXAMINE
APO-FLUVOXAMINE
NOVO-FLUVOXAMINE
PMS-FLUVOXAMINE
DOM-FLUVOXAMINE
LUVOX
98
* 100MG TABLET
02231193
02218461
02231330
02239954
02240683
02241348
01919369
NU-FLUVOXAMINE
RATIO-FLUVOXAMINE
APO-FLUVOXAMINE
NOVO-FLUVOXAMINE
PMS-FLUVOXAMINE
DOM-FLUVOXAMINE
LUVOX
NXP
RTP
APX
NOP
PMS
DOM
SLV
$
0.7738 *
0.9659
0.9659
0.9659
0.9659
1.0142
1.5331
APX
$
0.1126
APX
NVR
$
0.1791
0.2485
APX
NVR
$
0.3326
0.4619
NOP
$
0.1644
NOP
$
0.2241
NOP
$
0.4243
NOP
$
0.5794
ORG
$
1.3454
APX
NXP
NOP
$
0.2735
0.2735
0.2735
IMIPRAMINE
10MG TABLET
00360201
APO-IMIPRAMINE
* 25MG TABLET
00312797
00010472
APO-IMIPRAMINE
TOFRANIL
* 50MG TABLET
00326852
00010480
APO-IMIPRAMINE
TOFRANIL
MAPROTILINE
10MG TABLET
02158604
NOVO-MAPROTILINE
25MG TABLET
02158612
NOVO-MAPROTILINE
50MG TABLET
02158620
NOVO-MAPROTILINE
75MG TABLET
02158639
NOVO-MAPROTILINE
MIRTAZAPINE
30MG TABLET
02243910
REMERON
MOCLOBEMIDE
* 100MG TABLET
02232148
02237111
02239746
APO-MOCLOBEMIDE
NU-MOCLOBEMIDE
NOVO-MOCLOBEMIDE
99
* 150MG TABLET
02237112
02218410
02232150
02239747
02243218
02243348
00899356
NU-MOCLOBEMIDE
RATIO-MOCLOBEMIDE
APO-MOCLOBEMIDE
NOVO-MOCLOBEMIDE
PMS-MOCLOBEMIDE
DOM-MOCLOBEMIDE
MANERIX
NXP
RTP
APX
NOP
PMS
DOM
HLR
$
0.3176 *
0.3965
0.3965
0.3965
0.3965
0.4164
0.6444
NOP
APX
PMS
DOM
HLR
$
0.7786
0.7786
0.7786
0.9084
1.2655
APX
PMS
GPM
LIN
DOM
$
0.5570
0.5570
0.5570
0.5571
0.5849
DOM
PMS
LIN
APX
GPM
BMY
$
0.4809 *
0.6076
0.6076
0.6076
0.6076
0.8680
DOM
PMS
LIN
APX
GPM
BMY
$
0.4809 *
0.6076
0.6076
0.6076
0.6076
0.8680
DOM
PMS
APX
GPM
LIN
BMY
$
0.5610 *
0.7089
0.7089
0.7089
0.7090
1.0128
* 300MG TABLET
02239748
02240456
02243219
02243349
02166747
NOVO-MOCLOBEMIDE
APO-MOCLOBEMIDE
PMS-MOCLOBEMIDE
DOM-MOCLOBEMIDE
MANERIX
NEFAZODONE
* 50MG TABLET
02242822
02245101
02245202
02237397
02245754
APO-NEFAZODONE
PMS-NEFAZODONE
GEN-NEFAZODONE
LIN-NEFAZODONE
DOM-NEFAZODONE
* 100MG TABLET
02245755
02245102
02237398
02242823
02245203
02087375
DOM-NEFAZODONE
PMS-NEFAZODONE
LIN-NEFAZODONE
APO-NEFAZODONE
GEN-NEFAZODONE
SERZONE
* 150MG TABLET
02245756
02245103
02237399
02242824
02245204
02087383
DOM-NEFAZODONE
PMS-NEFAZODONE
LIN-NEFAZODONE
APO-NEFAZODONE
GEN-NEFAZODONE
SERZONE
* 200MG TABLET
02245757
02245111
02242825
02245205
02237400
02087391
DOM-NEFAZODONE
PMS-NEFAZODONE
APO-NEFAZODONE
GEN-NEFAZODONE
LIN-NEFAZODONE
SERZONE
100
NORTRIPTYLINE
* 10MG CAPSULE
02223139
02177692
02223511
02231686
02231781
02240789
02178729
00015229
NU-NORTRIPTYLINE
PMS-NORTRIPTYLINE
APO-NORTRIPTYLINE
GEN-NORTRIPTYLINE
NOVO-NORTRIPTYLINE
RATIO-NORTRIPTYLINE
DOM-NORTRIPTYLINE
AVENTYL
NXP
PMS
APX
GPM
NOP
RTP
DOM
PMS
$
0.1095 *
0.1368
0.1368
0.1368
0.1368
0.1368
0.1709
0.2170
NXP
NOP
PMS
APX
GPM
RTP
DOM
PMS
$
0.2215 *
0.2763
0.2764
0.2764
0.2764
0.2764
0.3455
0.4387
GSK
$
1.7771
GSK
$
1.8884
PFI
$
0.3633
* 25MG CAPSULE
02223147
02231782
02177706
02223538
02231687
02240790
02178737
00015237
NU-NORTRIPTYLINE
NOVO-NORTRIPTYLINE
PMS-NORTRIPTYLINE
APO-NORTRIPTYLINE
GEN-NORTRIPTYLINE
RATIO-NORTRIPTYLINE
DOM-NORTRIPTYLINE
AVENTYL
PAROXETINE HCL
20MG TABLET
01940481
PAXIL
30MG TABLET
01940473
PAXIL
PHENELZINE SO4
SEE NOTE REGARDING MONOAMINE OXIDASE INHIBITORS
UNDER SECTION 28:16.04
15MG TABLET
00476552
NARDIL
101
SERTRALINE HYDROCHLORIDE
* 25MG CAPSULE
02245748
02245159
02238280
02240485
02242519
02244838
02245787
02132702
DOM-SERTRALINE
RHOXAL-SERTRALINE
APO-SERTRALINE
NOVO-SERTRALINE
GEN-SERTRALINE
PMS-SERTRALINE
RATIO-SERTRALINE
ZOLOFT
DOM
RHO
APX
NOP
GPM
PMS
RTP
PFI
$
0.4327 *
0.5469
0.5469
0.5469
0.5469
0.5469
0.5469
0.9060
DOM
APX
NOP
GPM
PMS
RHO
RTP
PFI
$
0.8655 *
1.0937
1.0937
1.0937
1.0937
1.0937
1.0937
1.8120
DOM
APX
NOP
GPM
PMS
RHO
RTP
PFI
$
0.9466 *
1.1963
1.1963
1.1963
1.1963
1.1963
1.1963
1.8988
GSK
$
0.3734
NXP
BRI
PMS
RTP
NOP
APX
ICN
GPM
DOM
$
0.1924 *
0.2403
0.2403
0.2403
0.2403
0.2403
0.2403
0.2403
0.2792
* 50MG CAPSULE
02245749
02238281
02240484
02242520
02244839
02245160
02245788
01962817
DOM-SERTRALINE
APO-SERTRALINE
NOVO-SERTRALINE
GEN-SERTRALINE
PMS-SERTRALINE
RHOXAL-SERTRALINE
RATIO-SERTRALINE
ZOLOFT
* 100MG CAPSULE
02245750
02238282
02240481
02242521
02244840
02245161
02245789
01962779
DOM-SERTRALINE
APO-SERTRALINE
NOVO-SERTRALINE
GEN-SERTRALINE
PMS-SERTRALINE
RHOXAL-SERTRALINE
RATIO-SERTRALINE
ZOLOFT
TRANYLCYPROMINE SO4
SEE NOTE REGARDING MONOAMINE OXIDASE INHIBITORS
UNDER SECTION 28:16.04
10MG TABLET
01919598
PARNATE
TRAZODONE
* 50MG TABLET
02165384
00579351
01937227
02053187
02144263
02147637
02230284
02231683
02128950
NU-TRAZODONE
DESYREL
PMS-TRAZODONE
RATIO-TRAZODONE
NOVO-TRAZODONE
APO-TRAZODONE
TRAZOREL
GEN-TRAZODONE
DOM-TRAZODONE
102
* 100MG TABLET
02165392
02147645
00579378
01937235
02053195
02144271
02230285
02231684
02128969
NU-TRAZODONE
APO-TRAZODONE
DESYREL
PMS-TRAZODONE
RATIO-TRAZODONE
NOVO-TRAZODONE
TRAZOREL
GEN-TRAZODONE
DOM-TRAZODONE
NXP
APX
BRI
PMS
RTP
NOP
ICN
GPM
DOM
$
0.3439 *
0.4293
0.4293
0.4293
0.4293
0.4293
0.4293
0.4293
0.5093
APX
AVT
$
0.5639
0.8354
APX
ROP
NXP
AVT
$
0.0890
0.0890
0.0890
0.2462
APX
ROP
NOP
NXP
AVT
$
0.1129
0.1129
0.1129
0.1129
0.3171
APX
ROP
NOP
NXP
$
0.2169
0.2169
0.2169
0.2169
APX
ROP
NOP
NXP
AVT
$
0.3709
0.3709
0.3709
0.3709
1.0591
TRIMIPRAMINE
* 75MG CAPSULE
02070987
01926349
APO-TRIMIP
SURMONTIL
* 12.5MG TABLET
00740799
00761605
02020599
01926357
APO-TRIMIP
RHOTRIMINE
NU-TRIMIPRAMINE
SURMONTIL
* 25MG TABLET
00740802
00761613
01940430
02020602
01926322
APO-TRIMIP
RHOTRIMINE
NOVO-TRIPRAMINE
NU-TRIMIPRAMINE
SURMONTIL
* 50MG TABLET
00740810
00761621
01940449
02020610
APO-TRIMIP
RHOTRIMINE
NOVO-TRIPRAMINE
NU-TRIMIPRAMINE
* 100MG TABLET
00740829
00761648
01940457
02020629
01926284
APO-TRIMIP
RHOTRIMINE
NOVO-TRIPRAMINE
NU-TRIMIPRAMINE
SURMONTIL
103
VENLAFAXINE HCL
37.5MG TABLET
02103680
EFFEXOR
WYA
$
0.8463
WYA
$
1.6926
WYA
$
0.8463
WYA
$
1.6926
WYA
$
1.7903
NOP
$
0.0174
NOP
$
0.0364
NOP
$
0.0416
NOP
$
0.0695
RHO
$
0.0259
RHO
$
0.0376
RTP
RHO
$
0.2932
0.2932
SAB
RHO
$
1.0600
1.0600
NVR
$
1.0221
NVR
$
4.0780
75MG TABLET
02103702
EFFEXOR
37.5MG EXTENDED-RELEASE CAPSULE
02237279
EFFEXOR XR
02237280
EFFEXOR XR
02237282
EFFEXOR XR
28:16.08 PSYCHOTHERAPEUTIC AGENTS
(ANTIPSYCHOTIC AGENTS)
CHLORPROMAZINE
10MG TABLET
00232157
NOVO-CHLORPROMAZINE
25MG TABLET
00232823
NOVO-CHLORPROMAZINE
50MG TABLET
00232807
NOVO-CHLORPROMAZINE
100MG TABLET
00232831
NOVO-CHLORPROMAZINE
01929968
LARGACTIL
01929976
LARGACTIL
00690805
01929992
RATIO-CHLORPROMANYL-40
LARGACTIL
00743518
01929984
CHLORPROMAZINE
LARGACTIL
CLOZAPINE
25MG TABLET
00894737
CLOZARIL (EDS)
100MG TABLET
00894745
CLOZARIL (EDS)
104
02156032
FLUANXOL DEPOT
LUD
$
73.1900
LUD
$
73.1900
FLUANXOL
LUD
$
0.2528
FLUANXOL
LUD
$
0.5461
SQU
PMS
APX
$
25.1300
25.1300
25.1300
SQU
PMS
$
32.3200
32.3200
SQU
$
47.2600
APO-FLUPHENAZINE
APX
$
0.1823
APO-FLUPHENAZINE
APX
$
0.2214
APO-FLUPHENAZINE
APX
$
0.2735
SQU
$
0.9559
02156040
FLUANXOL DEPOT
FLUPENTHIXOL DIHYDROCHLORIDE
0.5MG TABLET
02156008
3MG TABLET
02156016
FLUPHENAZINE DECANOATE
00349917
02091275
02244166
MODECATE
PMS-FLUPHENAZINE DECAN.
APO-FLUPHENAZINE
00755575
02241928
MODECATE CONCENTRATE
FLUPHENAZINE ENANTHATE
00029173
MODITEN ENANTHATE
FLUPHENAZINE HCL
1MG TABLET
00405345
2MG TABLET
00410632
5MG TABLET
00405361
10MG TABLET
00582514
MODITEN
105
HALOPERIDOL
* 0.5MG TABLET
00363685
00396796
00552135
NOVO-PERIDOL
APO-HALOPERIDOL
RATIO-HALOPERIDOL
NOP
APX
RTP
$
0.0391
0.0391
0.0391
NOVO-PERIDOL
APO-HALOPERIDOL
RATIO-HALOPERIDOL
NOP
APX
RTP
$
0.0667
0.0667
0.0667
NOVO-PERIDOL
APO-HALOPERIDOL
NOP
APX
$
0.1140
0.1140
NOVO-PERIDOL
APO-HALOPERIDOL
RATIO-HALOPERIDOL
NOP
APX
RTP
$
0.1614
0.1614
0.1614
APX
NOP
$
0.1443
0.1443
RTP
PMS
APX
$
0.1165
0.1165
0.1274
SAB
$
3.5700
SAB
ROP
NOP
APX
$
30.4200
30.4200
30.4200
30.4200
SAB
ROP
APX
NOP
$
60.1100
60.1100
60.1100
60.1100
* 1MG TABLET
00363677
00396818
00552143
* 2MG TABLET
00363669
00396826
* 5MG TABLET
00363650
00396834
00647969
* 10MG TABLET
00463698
00713449
APO-HALOPERIDOL
NOVO-PERIDOL
00552429
00759503
00587702
RATIO-HALOPERIDOL
PMS-HALOPERIDOL
APO-HALOPERIDOL
00808652
HALOPERIDOL
HALOPERIDOL DECANOATE
02130297
02211130
02236866
02242361
HALOPERIDOL LA
RHO-HALOPERIDOL
HALOPERIDOL LONG ACTING
APO-HALOPERIDOL LA
02130300
02211149
02242362
02242631
HALOPERIDOL LA
RHO-HALOPERIDOL
APO-HALOPERIDOL LA
106
LOXAPINE SUCCINATE
* 5MG TABLET
02230837
02237534
02237651
02239918
PMS-LOXAPINE
NU-LOXAPINE
APO-LOXAPINE
DOM-LOXAPINE
PMS
NXP
APX
DOM
$
0.1628
0.1628
0.1628
0.1709
PMS
NXP
APX
DOM
$
0.2711
0.2711
0.2711
0.2846
PMS
NXP
APX
DOM
$
0.4202
0.4202
0.4202
0.4412
PMS
NXP
APX
DOM
$
0.5601
0.5601
0.5601
0.5881
ZYPREXA (EDS)
LIL
$
1.8310
ZYPREXA (EDS)
LIL
$
3.6619
LIL
$
5.4929
LIL
$
7.2500
LIL
$
10.6250
LIL
$
3.6619
LIL
$
7.3238
* 10MG TABLET
02230838
02237535
02237652
02239919
PMS-LOXAPINE
NU-LOXAPINE
APO-LOXAPINE
DOM-LOXAPINE
* 25MG TABLET
02230839
02237536
02237653
02239920
PMS-LOXAPINE
NU-LOXAPINE
APO-LOXAPINE
DOM-LOXAPINE
* 50MG TABLET
02230840
02237537
02237654
02239921
PMS-LOXAPINE
NU-LOXAPINE
APO-LOXAPINE
DOM-LOXAPINE
OLANZAPINE
2.5MG TABLET
02229250
5MG TABLET
02229269
7.5MG TABLET
02229277
ZYPREXA (EDS)
10MG TABLET
02229285
ZYPREXA (EDS)
15MG TABLET
02238850
ZYPREXA (EDS)
5MG ORALLY DISINTEGRATING TABLET
02243086
ZYPREXA ZYDIS (EDS)
10MG ORALLY DISINTEGRATING TABLET
02243087
ZYPREXA ZYDIS (EDS)
107
PERICYAZINE
5MG CAPSULE
01926780
NEULEPTIL
AVT
$
0.1817
AVT
$
0.4413
AVT
$
0.3076
APO-PERPHENAZINE
APX
$
0.0239
APO-PERPHENAZINE
APX
$
0.0348
APO-PERPHENAZINE
APX
$
0.0456
APO-PERPHENAZINE
APX
$
0.0565
ORAP
PMS
$
0.3851
ORAP
PMS
$
0.6988
AVT
$
13.1800
AVT
$
42.4300
APX
RHO
NXP
$
0.1145
0.1145
0.1145
APX
RHO
NXP
$
0.1400
0.1400
0.1400
20MG CAPSULE
01926764
NEULEPTIL
10MG/ML ORAL DROPS
01926756
NEULEPTIL
PERPHENAZINE
2MG TABLET
00335134
4MG TABLET
00335126
8MG TABLET
00335118
16MG TABLET
00335096
PIMOZIDE
2MG TABLET
00313815
4MG TABLET
00313823
PIPOTIAZINE PALMITATE
01926667
PIPORTIL L4
01926675
PIPORTIL L4
PROCHLORPERAZINE
* 5MG TABLET
00886440
01927752
01964399
APO-PROCHLORAZINE
STEMETIL
NU-PROCHLOR
* 10MG TABLET
00886432
01927760
01964402
APO-PROCHLORAZINE
STEMETIL
NU-PROCHLOR
108
01927787
STEMETIL
RHO
$
0.0552
SAB
RHO
$
1.0800
1.0800
RHO
$
0.9006
AST
$
0.5208
AST
$
1.3888
AST
$
2.1483
AST
$
2.7885
AST
$
4.0500
JAN
$
0.4842
RISPERDAL
JAN
$
0.8108
RISPERDAL
JAN
$
1.1198
RISPERDAL
JAN
$
2.2357
RISPERDAL
JAN
$
3.3534
RISPERDAL
JAN
$
4.4712
JAN
$
1.2876
00789747
01927779
PROCHLORPERAZINE MESYLATE
STEMETIL
10MG SUPPOSITORY
01927795
STEMETIL
QUETIAPINE
25MG TABLET
02236951
SEROQUEL (EDS)
100MG TABLET
02236952
SEROQUEL (EDS)
150MG TABLET
02240862
SEROQUEL (EDS)
200MG TABLET
02236953
SEROQUEL (EDS)
300MG TABLET
02244107
SEROQUEL (EDS)
RISPERIDONE
0.25MG TABLET
02240551
RISPERDAL
0.5MG TABLET
02240552
1MG TABLET
02025280
2MG TABLET
02025299
3MG TABLET
02025302
4MG TABLET
02025310
02236950
RISPERDAL
109
THIORIDAZINE
10MG TABLET
00360228
APO-THIORIDAZINE
APX
$
0.0923
APX
$
0.1107
APX
$
0.1313
APX
$
0.2577
PMS
$
0.1133
PFI
$
0.2089
PFI
$
0.3591
PFI
$
0.4623
APO-TRIFLUOPERAZINE
APX
$
0.1102
APO-TRIFLUOPERAZINE
APX
$
0.1443
APO-TRIFLUOPERAZINE
APX
$
0.1915
APX
$
0.2295
PMS
$
0.2700
LUD
$
15.1900
LUD
$
151.9000
25MG TABLET
00360198
APO-THIORIDAZINE
50MG TABLET
00360236
APO-THIORIDAZINE
100MG TABLET
00360244
APO-THIORIDAZINE
00775320
PMS-THIORIDAZINE
THIOTHIXENE
2MG CAPSULE
00024430
NAVANE
5MG CAPSULE
00024449
NAVANE
10MG CAPSULE
00024457
NAVANE
TRIFLUOPERAZINE
1MG TABLET
00345539
2MG TABLET
00312754
5MG TABLET
00312746
10MG TABLET
00326836
APO-TRIFLUOPERAZINE
00751871
PMS-TRIFLUOPERAZINE
ZUCLOPENTHIXOL ACETATE
02230405
CLOPIXOL ACUPHASE (EDS)
ZUCLOPENTHIXOL DECANOATE
02230406
CLOPIXOL DEPOT (EDS)
110
ZUCLOPENTHIXOL DIHYDROCHLORIDE
10MG TABLET
02230402
CLOPIXOL (EDS)
LUD
$
0.3906
LUD
$
0.9765
LUD
$
1.5624
25MG TABLET
02230403
CLOPIXOL (EDS)
40MG TABLET
02230404
CLOPIXOL (EDS)
28:20.00 RESPIRATORY AND CEREBRAL STIMULANTS
DEXTROAMPHETAMINE SO4
5MG TABLET
01924516
DEXEDRINE
GSK
$
0.3082
GSK
$
0.4421
GSK
$
0.5405
PMS
$
0.1028
PMS
RTP
NVR
$
0.1726
0.1726
0.2831
PMS
RTP
NVR
$
0.3958
0.3958
0.4948
NVR
$
0.5215
DPY
$
1.3020
10MG SPANSULE CAPSULE
01924559
DEXEDRINE
15MG SPANSULE CAPSULE
01924567
DEXEDRINE
METHYLPHENIDATE HCL
5MG TABLET
02234749
PMS-METHYLPHENIDATE
* 10MG TABLET
00584991
02230321
00005606
PMS-METHYLPHENIDATE
RATIO-METHYLPHENIDATE
RITALIN
* 20MG TABLET
00585009
02230322
00005614
PMS-METHYLPHENIDATE
RITALIN
00632775
RITALIN SR
MODAFINIL
100MG TABLET
02239665
ALERTEC (EDS)
111
28:24.04 ANXIOLYTICS,SEDATIVES AND HYPNOTICS
(BARBITURATES)
AMOBARBITAL SODIUM
60MG CAPSULE
00015148
AMYTAL SODIUM
PMS
$
0.1042
PMS
$
0.2294
ABB
$
0.2212
PMS
$
0.1160
NXP
APX
RTP
NOP
GPM
MED
PHU
$
0.0661 *
0.0825
0.0825
0.0825
0.0825
0.0825
0.2540
NXP
RTP
APX
NOP
GPM
MED
PHU
$
0.0800 *
0.0999
0.0999
0.0999
0.0999
0.0999
0.3037
200MG CAPSULE
00015156
AMYTAL SODIUM
PENTOBARBITAL SODIUM
100MG CAPSULE
00000086
NEMBUTAL
PHENOBARBITAL
SEE SECTION 28:12.04 (ANTICONVULSANTS)
SECOBARBITAL SODIUM
100MG CAPSULE
00015288
SECONAL
(BENZODIAZEPINES)
ALPRAZOLAM
* 0.25MG TABLET
01913239
00865397
00677485
01913484
02137534
02237264
00548359
NU-ALPRAZ
APO-ALPRAZ
RATIO-ALPRAZOLAM
NOVO-ALPRAZOL
GEN-ALPRAZOLAM
MED-ALPRAZOLAM
XANAX
* 0.5MG TABLET
01913247
00677477
00865400
01913492
02137542
02237265
00548367
NU-ALPRAZ
RATIO-ALPRAZOLAM
APO-ALPRAZ
NOVO-ALPRAZOL
GEN-ALPRAZOLAM
MED-ALPRAZOLAM
XANAX
112
(BENZODIAZEPINES)
BROMAZEPAM
* 1.5MG TABLET
02171858
02177153
02192705
02230666
00682314
NU-BROMAZEPAM
APO-BROMAZEPAM
GEN-BROMAZEPAM
MED-BROMAZEPAM
LECTOPAM
NXP
APX
GPM
MED
HLR
$
0.0752
0.0752
0.0752
0.0752
0.1118
NU-BROMAZEPAM
APO-BROMAZEPAM
GEN-BROMAZEPAM
NOVO-BROMAZEPAM
MED-BROMAZEPAM
LECTOPAM
NXP
APX
GPM
NOP
MED
HLR
$
0.0767 *
0.0957
0.0957
0.0957
0.0957
0.1519
NU-BROMAZEPAM
APO-BROMAZEPAM
GEN-BROMAZEPAM
NOVO-BROMAZEPAM
MED-BROMAZEPAM
LECTOPAM
NXP
APX
GPM
NOP
MED
HLR
$
0.1398
0.1398
0.1398
0.1398
0.1398
0.2219
APX
$
0.0527
APX
$
0.0830
APX
$
0.1286
NOP
APX
$
0.0753
0.0753
NOP
APX
$
0.1662
0.1662
NOP
APX
$
0.2840
0.2840
* 3MG TABLET
02171864
02177161
02192713
02230584
02230667
00518123
* 6MG TABLET
02171872
02177188
02192721
02230585
02230668
00518131
CHLORDIAZEPOXIDE
5MG CAPSULE
00522724
APO-CHLORDIAZEPOXIDE
10MG CAPSULE
00522988
25MG CAPSULE
00522996
CLORAZEPATE DIPOTASSIUM
* 3.75MG CAPSULE
00628190
00860689
NOVO-CLOPATE
APO-CLORAZEPATE
* 7.5MG CAPSULE
00628204
00860700
NOVO-CLOPATE
APO-CLORAZEPATE
* 15MG CAPSULE
00628212
00860697
NOVO-CLOPATE
APO-CLORAZEPATE
113
(BENZODIAZEPINES)
DIAZEPAM
2MG TABLET
00405329
APO-DIAZEPAM
APX
$
0.0662
VIVOL
APO-DIAZEPAM
VALIUM
HOR
APX
HLR
$
0.0952
0.0977
0.1552
APX
HOR
$
0.1129
0.1561
DPY
$
72.9700
APX
ICN
$
0.0879
0.1330
APX
ICN
$
0.1009
0.1557
APO-LORAZEPAM
NOVO-LORAZEM
PMS-LORAZEPAM
NU-LORAZ
DOM-LORAZEPAM
ATIVAN
APX
NOP
PMS
NXP
DOM
WYA
$
0.0390
0.0390
0.0390
0.0390
0.0409
0.0814
NOVO-LORAZEM
APO-LORAZEPAM
PMS-LORAZEPAM
NU-LORAZ
DOM-LORAZEPAM
ATIVAN
NOP
APX
PMS
NXP
DOM
WYA
$
0.0485
0.0485
0.0485
0.0485
0.0509
0.1009
NOVO-LORAZEM
APO-LORAZEPAM
PMS-LORAZEPAM
NU-LORAZ
DOM-LORAZEPAM
ATIVAN
NOP
APX
PMS
NXP
DOM
WYA
$
0.0759
0.0759
0.0759
0.0759
0.0797
0.1585
* 5MG TABLET
00013765
00362158
00013285
* 10MG TABLET
00405337
00013773
APO-DIAZEPAM
VIVOL
5MG/ML RECTAL GEL (DELIVERY SYSTEM)
02238162
DIASTAT
FLURAZEPAM HCL
* 15MG CAPSULE
00521698
00012696
APO-FLURAZEPAM
DALMANE
* 30MG CAPSULE
00521701
00012718
APO-FLURAZEPAM
DALMANE
LORAZEPAM
* 0.5MG TABLET
00655740
00711101
00728187
00865672
02245784
02041413
* 1MG TABLET
00637742
00655759
00728195
00865680
02245785
02041421
* 2MG TABLET
00637750
00655767
00728209
00865699
02245786
02041448
114
(BENZODIAZEPINES)
OXAZEPAM
10MG TABLET
00402680
APO-OXAZEPAM
APX
$
0.0456
APX
$
0.0717
APX
$
0.0977
NXP
APX
PMS
NOP
GPM
MED
RTP
DOM
NVR
$
0.0959 *
0.1196
0.1196
0.1196
0.1196
0.1196
0.1196
0.1493
0.1899
NXP
APX
NOP
PMS
GPM
MED
RTP
DOM
NVR
$
0.1153 *
0.1439
0.1439
0.1439
0.1439
0.1439
0.1439
0.1795
0.2284
APX
GPM
NOP
$
0.0604
0.0604
0.0606
APX
NOP
GPM
PHU
$
0.0760
0.0760
0.0760
0.2199
15MG TABLET
00402745
APO-OXAZEPAM
30MG TABLET
00402737
APO-OXAZEPAM
TEMAZEPAM
* 15MG CAPSULE
02223570
02225964
02229455
02230095
02231615
02237294
02243023
02229756
00604453
NU-TEMAZEPAM
APO-TEMAZEPAM
PMS-TEMAZEPAM
NOVO-TEMAZEPAM
GEN-TEMAZEPAM
MED-TEMAZEPAM
RATIO-TEMAZEPAM
DOM-TEMAZEPAM
RESTORIL
* 30MG CAPSULE
02223589
02225972
02230102
02229456
02231616
02237295
02243024
02229758
00604461
NU-TEMAZEPAM
APO-TEMAZEPAM
NOVO-TEMAZEPAM
PMS-TEMAZEPAM
GEN-TEMAZEPAM
MED-TEMAZEPAM
RATIO-TEMAZEPAM
DOM-TEMAZEPAM
RESTORIL
TRIAZOLAM
* 0.125MG TABLET
00808563
01995227
00872423
APO-TRIAZO
GEN-TRIAZOLAM
NOVO-TRIOLAM
* 0.25MG TABLET
00808571
00872431
01913506
00443158
APO-TRIAZO
NOVO-TRIOLAM
GEN-TRIAZOLAM
HALCION
115
28:24.92 MISCELLANEOUS ANXIOLYTICS,SEDATIVES
AND HYPNOTICS
BUSPIRONE
5MG TABLET
02230941
PMS-BUSPIRONE
PMS
$
0.4323
DOM
LIN
NXP
APX
GPM
PMS
NOP
MED
RTP
BRI
$
0.5531 *
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
1.0498
PMS
$
0.0471
APX
NOP
$
0.0361
0.0361
APX
NOP
$
0.0584
0.0584
APX
NOP
$
0.0814
0.0814
PMS
PFI
$
0.0422
0.0515
* 10MG TABLET
02232564
02176122
02207672
02211076
02230874
02230942
02231492
02237268
02237858
00603821
DOM-BUSPIRONE
LIN-BUSPIRONE
NU-BUSPIRONE
APO-BUSPIRONE
GEN-BUSPIRONE
PMS-BUSPIRONE
NOVO-BUSPIRONE
MED-BUSPIRONE
RATIO-BUSPIREX
BUSPAR
CHLORAL HYDRATE
100MG/ML SYRUP
00792659
PMS-CHLORAL HYDRATE SYRUP
HYDROXYZINE
* 10MG CAPSULE
00646059
00738824
APO-HYDROXYZINE
NOVO-HYDROXYZIN
* 25MG CAPSULE
00646024
00738832
APO-HYDROXYZINE
NOVO-HYDROXYZIN
* 50MG CAPSULE
00646016
00738840
APO-HYDROXYZINE
NOVO-HYDROXYZIN
* 2MG/ML ORAL SYRUP
00741817
00024694
PMS-HYDROXYZINE
ATARAX
116
28:24.92 MISCELLANEOUS ANXIOLYTICS,SEDATIVES
AND HYPNOTICS
METHOTRIMEPRAZINE
* 2MG TABLET
01927647
02238403
NOZINAN
APO-METHOPRAZINE
RHO
APX
$
0.0548
0.0548
NOZINAN
NOVO-MEPRAZINE
PMS-METHOTRIMEPRAZINE
APO-METHOPRAZINE
RHO
NOP
PMS
APX
$
0.0573
0.0573
0.0573
0.0573
RHO
NOP
PMS
APX
$
0.1228
0.1228
0.1228
0.1228
RHO
NOP
PMS
APX
$
0.1672
0.1672
0.1672
0.1672
RHO
$
0.0609
RHO
$
0.4451
PMS
APX
ICN
$
0.0578
0.0578
0.1238
PMS
APX
ICN
$
0.0606
0.0606
0.1017
PMS
ICN
$
0.1476
0.1845
JAN
$
0.2068
* 5MG TABLET
01927655
01964909
02232903
02238404
* 25MG TABLET
01927663
01964925
02232904
02238405
NOZINAN
NOVO-MEPRAZINE
APO-METHOPRAZINE
* 50MG TABLET
01927671
01964933
02232905
02238406
NOZINAN
NOVO-MEPRAZINE
APO-METHOPRAZINE
01927728
NOZINAN
01927701
NOZINAN
28:28.00 ANTIMANIC AGENTS
LITHIUM CARBONATE
* 150MG CAPSULE
02216132
02242837
00461733
PMS-LITHIUM CARBONATE
APO-LITHIUM CARBONATE
CARBOLITH
* 300MG CAPSULE
02216140
02242838
00236683
CARBOLITH
* 600MG CAPSULE
02216159
02011239
CARBOLITH
00590665
DURALITH
117
DIAGNOSTIC AGENTS
36:00
36:00 DIAGNOSTIC AGENTS
36:04.00 ADRENAL INSUFFICIENCY
COSYNTROPIN ZINC HYDROXIDE
SEE SECTION 68:28.00 (PITUITARY AGENTS)
36:26.00 DIABETES MELLITUS
NOTE: THE IDENTIFICATION NUMBERS LISTED IN THIS SECTION
HAVE BEEN GENERATED BY THE PRESCRIPTION DRUG PLAN FOR
BILLING PURPOSES ONLY.
GLUCOSE OXIDASE/PEROXIDASE REAGENT
⌧
STRIP
00950889
00950831
00950378
00950408
00950432
00950505
00950068
00950907
00950300
00950878
00950893
00950894
00950902
00950459
00950734
00950883
00950900
00950572
00950882
NOVO-GLUCOSE
PRESTIGE
GLUCOFILM
GLUCOSTIX
ACCUTREND
ENCORE
CHEMSTRIP BG
FREESTYLE
PRECISION PLUS
ASCENSIA DEX
ONE TOUCH ULTRA
PRECISION XTRA
SOF-TACT
ONE TOUCH
SURESTEP
ADVANTAGE COMFORT
ACCU-CHEK COMPACT
ELITE
FASTTAKE
NOP
THR
BAY
BAY
BOM
BAY
BOM
THS
MDS
BAY
LSN
MDS
MDS
LSN
LSN
BOM
BOM
BAY
LSN
$
0.6011
0.6270
0.7012
0.7012
0.7324
0.7324
0.7834
0.8029
0.8626
0.8626
0.8626
0.8626
0.8626
0.8663
0.8663
0.8680
0.8680
0.9388
0.9388
MDS
$
1.6344
HYDROXYBUTYRATE DEHYDROGENASE
BLOOD KETONE TEST STRIP
00950896
PRECISION XTRA KETONE
120
36:00 DIAGNOSTIC AGENTS
36:88.00 URINE CONTENTS
NOTE: THE IDENTIFICATION NUMBERS LISTED IN THIS SECTION
HAVE BEEN GENERATED BY THE PRESCRIPTION DRUG PLAN FOR
BILLING PURPOSES ONLY.
CUPRIC SO4 REAGENT
TABLET
00035122
CLINITEST
BAY
$
0.0998
BAY
$
0.1129
BOM
$
0.1389
BAY
$
0.1354
KETOSTIX
BAY
$
0.1259
ACETEST
BAY
$
0.1728
GLUCOSE OXIDASE/PEROXIDASE REAGENT
STICK
00035130
DIASTIX
GLUCOSE OXIDASE/PEROXIDASE/SODIUM
NITROFERRICYANIDE/GLYCINE REAGENT
STICK
00950238
CHEMSTRIP UG 5000K
GLUCOSE OXIDASE/PEROXIDASE/SODIUM
NITROPRUSSIDE REAGENT
STICK
00035149
KETO DIASTIX
SODIUM NITROPRUSSIDE REAGENT
STICK
00035092
TABLET
00035106
121
ELECTROLYTIC, CALORIC AND
WATER BALANCE
40:00
40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE
40:12.00 REPLACEMENT AGENTS
POTASSIUM CHLORIDE
8MMOL LONG ACTING CAPSULE
02042304
⌧
MICRO-K EXTENCAPS
WYA
$
0.0971
APX
NVR
$
0.0586
0.1040
KEY
$
0.2165
PMS
GSK
$
0.0139
0.0157
ABB
$
0.3165
WEL
$
0.5191
SAW
$
0.3031
PMS
$
0.1027
PMS
SAW
$
0.1172
0.1569
PMS
$
14.8000
8MMOL LONG ACTING TABLET
00602884
00074225
APO-K
SLOW-K
20MMOL LONG ACTING TABLET
00713376
K-DUR
* 1.33MMOL/ML ORAL SOLUTION
02238604
01918303
PMS-POTASSIUM CHLORIDE
K-10
20MMOL/PACKAGE POWDER (3G)
00481211
K-LOR
25MMOL/PACKAGE POWDER (7.8G)
02089580
K-LYTE/CL
40:18.00 POTASSIUM-REMOVING RESINS
CALCIUM POLYSTYRENE SULFONATE
POWDER (1G BINDS WITH APPROX. 1.6MMOL. K)
02017741
RESONIUM CALCIUM
SODIUM POLYSTYRENE SULFONATE
00769541
PMS-SOD POLYSTYRENE SULF
* POWDER (1G BINDS WITH APPROX.1MMOL K IN VIVO)
00755338
02026961
KAYEXALATE
250MG/ML RETENTION ENEMA
00769533
PMS-SOD POLY SULF (120ML)
124
40:28.00 DIURETICS
ACETAZOLAMIDE
SEE SECTION 52:10.00 (CARBONIC ANHYDRASE INHIBITORS)
BUMETANIDE
1MG TABLET
00728284
BURINEX (EDS)
LEO
$
0.7324
BURINEX (EDS)
LEO
$
1.4648
BURINEX (EDS)
LEO
$
2.7939
APX
$
0.0852
APX
$
0.1020
MSD
$
0.3440
NOP
APX
AVT
$
0.0483
0.0483
0.0749
NOP
APX
AVT
$
0.0727
0.0727
0.1147
AVT
$
0.2356
NOP
APX
MSD
$
0.0516
0.0516
0.0795
NOP
APX
$
0.0706
0.0706
2MG TABLET
02176076
5MG TABLET
00728276
CHLORTHALIDONE
50MG TABLET
00360279
APO-CHLORTHALIDONE
100MG TABLET
00360287
APO-CHLORTHALIDONE
ETHACRYNIC ACID
50MG TABLET
00016497
EDECRIN (EDS)
FUROSEMIDE
* 20MG TABLET
00337730
00396788
02224690
NOVO-SEMIDE
APO-FUROSEMIDE
LASIX
* 40MG TABLET
00337749
00362166
02224704
NOVO-SEMIDE
APO-FUROSEMIDE
LASIX
02224720
LASIX
HYDROCHLOROTHIAZIDE
* 25MG TABLET
00021474
00326844
00016500
NOVO-HYDRAZIDE
APO-HYDRO
HYDRODIURIL
* 50MG TABLET
00021482
00312800
NOVO-HYDRAZIDE
APO-HYDRO
125
40:28.00 DIURETICS
INDAPAMIDE HEMIHYDRATE
* 1.25MG TABLET
02239913
02227339
02239619
02240067
02179709
DOM-INDAPAMIDE
INDAPAMIDE
PMS-INDAPAMIDE
GEN-INDAPAMIDE
LOZIDE
DOM
PRO
PMS
GPM
SEV
$
0.1672 *
0.2037
0.2037
0.2037
0.3254
DOM
PRO
GPM
NXP
APX
NOP
PMS
SEV
$
0.2652 *
0.3230
0.3230
0.3230
0.3230
0.3230
0.3230
0.5289
AVT
$
0.1585
MSD
$
0.3104
PHU
NOP
$
0.0751
0.0751
PHU
NOP
$
0.2301
0.2301
* 2.5MG TABLET
02239917
02049341
02153483
02223597
02223678
02231184
02239620
00564966
DOM-INDAPAMIDE
INDAPAMIDE
GEN-INDAPAMIDE
NU-INDAPAMIDE
APO-INDAPAMIDE
NOVO-INDAPAMIDE
PMS-INDAPAMIDE
LOZIDE
METOLAZONE
2.5MG TABLET
00888400
ZAROXOLYN
40:28.10 POTASSIUM SPARING DIURETICS
AMILORIDE HCL
5MG TABLET
00487805
MIDAMOR
SPIRONOLACTONE
* 25MG TABLET
00028606
00613215
ALDACTONE
NOVO-SPIROTON
* 100MG TABLET
00285455
00613223
ALDACTONE
NOVO-SPIROTON
126
40:40.00 URICOSURIC DRUGS
PROBENECID
500MG TABLET
00294926
BENURYL
ICN
$
0.2045
APX
NXP
$
0.1519
0.1519
APX
NXP
$
0.2149
0.2149
SULFINPYRAZONE
* 100MG TABLET
00441759
02045680
APO-SULFINPYRAZONE
NU-SULFINPYRAZONE
* 200MG TABLET
00441767
02045699
APO-SULFINPYRAZONE
NU-SULFINPYRAZONE
127
COUGH PREPARATIONS
48:00
48:00 COUGH PREPARATIONS
48:24.00 MUCOLYTIC AGENTS
ACETYLCYSTEINE
* 20% SOLUTION (30ML)
02243098
02091526
ACETYLCYSTEINE SOLUTION
MUCOMYST
SAB
WEL
$
15.8600
19.1600
HLR
$
36.0000
DORNASE ALFA
1MG/ML INHALATION SOLUTION (2.5ML)
02046733
PULMOZYME (EDS)
130
EYE, EAR, NOSE AND THROAT
PREPARATIONS
52:00
52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS
52:04.04 ANTI-INFECTIVES (ANTIBIOTICS)
FUSIDIC ACID
1% OPHTHALMIC DROPS (PRESERVATIVE FREE)
02243861
FUCITHALMIC (EDS)
LEO
$
0.8190
LEO
$
1.7620
1% OPHTHALMIC DROPS (G)
02243862
FUCITHALMIC (EDS)
GENTAMICIN SO4
TOPICAL GENTAMICIN SHOULD BE RESERVED FOR THERAPY OF SERIOUS
INFECTIONS INSUSCEPTIBLE TO OTHER AGENTS SINCE RESISTANT
ORGANISMS CAN DEVELOP.
GENTAMICIN SO4 5MG/ML IS EQUIVALENT TO 3MG/ML GENTAMICIN BASE.
* 5MG/ML OPHTHALMIC SOLUTION
00512192
00776521
02229440
00436771
GARAMYCIN
PMS-GENTAMYCIN
GENTAMICIN SULFATE
ALCOMICIN
SCH
PMS
SAB
ALC
$
0.4406
0.4406
0.4406
0.5187
SAB
PMS
SCH
$
1.1192
1.1198
1.1998
SCH
SAB
$
4.3400
4.3400
* 5MG/ML OTIC SOLUTION
02229441
02230889
00512184
GENTAMICIN SO4
PMS-GENTAMICIN
GARAMYCIN
* 5MG/G OPHTHALMIC OINTMENT (3.5G)
00028339
02230888
GARAMYCIN
GENTAMICIN SULFATE
POLYMYXIN B SO4/NEOMYCIN SO4/BACITRACIN(ZINC)
10,000U/5MG/400U PER G OPHTHALMIC OINTMENT
(3.5G)
00694398
NEOSPORIN
GSK
$
8.1400
SAB
GSK
$
0.6782
0.7975
PMS
ALL
$
0.7194
2.6203
POLYMYXIN B SO4/NEOMYCIN SO4/GRAMICIDIN
* 10,000U/2.5MG/0.025MG PER ML EYE/EAR SOLUTION
00807435
00694371
OPTIMYXIN PLUS
NEOSPORIN
POLYMYXIN B SO4/TRIMETHOPRIM SO4
* 10,000U/1MG PER ML OPHTHALMIC SOLUTION
02240363
02011956
PMS-POLYTRIMETHOPRIM
POLYTRIM
132
TOBRAMYCIN
* 0.3% OPHTHALMIC SOLUTION
02239577
02241755
00513962
PMS-TOBRAMYCIN (EDS)
SAB-TOBRAMYCIN (EDS)
TOBREX (EDS)
PMS
SAB
ALC
$
1.1371
1.1371
1.8077
ALC
$
8.9800
THM
$
33.4800
AKN
SCH
$
0.0789
0.0876
ALC
$
3.1000
STI
$
0.2387
ALC
$
2.1049
ALC
$
10.5300
0.3% OPHTHALMIC OINTMENT (3.5G)
00614254
TOBREX (EDS)
52:04.06 ANTI-INFECTIVES (ANTIVIRALS)
TRIFLURIDINE
1% OPHTHALMIC SOLUTION (7.5ML)
00687456
VIROPTIC
52:04.08 ANTI-INFECTIVES (SULFONAMIDES)
SULFACETAMIDE (SODIUM)
* 10% OPHTHALMIC SOLUTION
02023830
00028053
DIOSULF
SODIUM SULAMYD
10% OPHTHALMIC OINTMENT (3.5G)
00252522
CETAMIDE
52:04.12 ANTI-INFECTIVES (MISCELLANEOUS)
ALUMINUM ACETATE/BENZETHONIUM CHLORIDE
0.5%/0.03% OTIC SOLUTION
00674222
BURO-SOL-OTIC
CIPROFLOXACIN
0.3% OPHTHALMIC SOLUTION
01945270
CILOXAN (EDS)
02200864
CILOXAN (EDS)
133
52:04.12 ANTI-INFECTIVES (MISCELLANEOUS)
NORFLOXACIN
01908294
NOROXIN (EDS)
MSD
$
1.7686
ALL
$
2.1049
RTP
GPM
MED
NXP
APX
$
13.3100
13.3100
13.3100
13.3100
13.3100
RBP
$
3.2724
GPM
AST
$
9.1500
10.7700
GPM
$
13.8300
AST
$
23.9300
ALC
$
1.6709
SAB
PMS
AKN
$
0.7335
0.7335
0.9071
ALC
$
9.0600
OFLOXACIN
02143291
OCUFLOX (EDS)
52:08.00 ANTI-INFLAMMATORY AGENTS
BECLOMETHASONE DIPROPIONATE
* 50UG/DOSE AQUEOUS NASAL SPRAY (PACKAGE)
00872318
02172712
02237379
02238577
02238796
RATIO-BECLOMETHASONE AQ.
GEN-BECLO AQ.
MED-BECLOMETHASONE AQ
NU-BECLOMETHASONE
APO-BECLOMETHASONE
BETAMETHASONE DISODIUM PHOSPHATE
0.1% OPHTHALMIC/OTIC SOLUTION
02060868
BETNESOL
BUDESONIDE
* 64UG/DOSE NASAL SPRAY (PACKAGE)
02241003
02231923
GEN-BUDESONIDE AQ
RHINOCORT AQUA
100UG/DOSE NASAL SPRAY (PACKAGE)
02230648
GEN-BUDESONIDE AQ
100UG POWDER FOR INHALATION (PACKAGE)
02035324
RHINOCORT TURBUHALER
DEXAMETHASONE
0.1% OPHTHALMIC SUSPENSION
00042560
MAXIDEX
* 0.1% OPHTHALMIC/OTIC SOLUTION
00739839
00785261
02023865
DEXAMETHASONE SODIUM PHO
PMS-DEXAMETHASONE SOD PHO
DIODEX
00042579
MAXIDEX
134
FLUNISOLIDE
* 0.025% NASAL SOLUTION (PACKAGE)
00878790
01927167
02239288
02162687
RATIO-FLUNISOLIDE
RHINARIS-F
APO-FLUNISOLIDE
RHINALAR
RTP
PMS
APX
HLR
$
15.0400
15.0400
15.0400
21.4900
PMS
ALL
$
1.7556
2.1939
ALC
$
1.8879
ALL
$
5.0062
GSK
$
24.0500
ALL
$
3.4720
SCH
$
26.5200
SAB
ALL
$
1.1501
1.5473
RTP
SAB
AKN
ALL
$
0.6293
0.6293
0.6293
3.7954
FLUOROMETHOLONE
* 0.1% OPHTHALMIC SUSPENSION
02238568
00247855
PMS-FLUOROMETHOLONE
FML
FLUOROMETHOLONE ACETATE
00756784
FLAREX
FLURBIPROFEN SODIUM
00766046
OCUFEN (EDS)
FLUTICASONE PROPIONATE
50UG/DOSE AQUEOUS NASAL SPRAY (PACKAGE)
02213672
FLONASE
KETOROLAC TROMETHAMINE
01968300
ACULAR (EDS)
MOMETASONE FUROATE MONOHYDRATE
0.05% AQUEOUS NASAL SPRAY
02238465
NASONEX
PREDNISOLONE ACETATE
01916181
00299405
PREDNISOLONE
PRED MILD
00700401
01916203
02023768
00301175
RATIO-PREDNISOLONE
PREDNISOLONE
DIOPRED
PRED FORTE
135
PREDNISOLONE SODIUM PHOSPHATE
02133296
INFLAMASE MILD
NVO
$
1.6731
NVO
$
1.5190
AVT
$
23.3800
ALC
$
2.2790
1% OPHTHALMIC SOLUTION
02133318
INFLAMASE FORTE
TRIAMCINOLONE ACETONIDE
AQUEOUS NASAL SPRAY (PACKAGE)
02213834
NASACORT AQ
52:08.00 COMBINATION ANTI-INFECTIVE/
ANTI-INFLAMMATORY AGENTS
CIPROFLOXACIN/HYDROCORTISONE
0.2%/1% OTIC SUSPENSION
02240035
CIPRO HC (EDS)
FRAMYCETIN SO4/GRAMICIDIN/DEXAMETHASONE BASE
5MG/50UG/0.5MG PER ML EYE/EAR SOLUTION
02224623
SOFRACORT
AVT
$
1.5190
AVT
$
10.4200
5MG/50UG/0.5MG PER G EYE/EAR OINTMENT (5G)
02224631
SOFRACORT
GENTAMICIN SO4/BETAMETHASONE SODIUM PHOSPHATE
0.3%/0.1% OPHTHALMIC OINTMENT (3.5G)
00586706
GARASONE
SCH
$
11.0000
SAB
SCH
$
1.5904
1.9872
* 0.3%/0.1% OTIC/OPHTHALMIC SOLUTION
02244999
00682217
SAB-PENTASONE
GARASONE
IODOCHLORHYDROXYQUIN/FLUMETHASONE PIVALATE
1%/0.02% OTIC SOLUTION
00074454
LOCACORTEN-VIOFORM
PAL
$
1.3715
GSK
$
10.5200
POLYMYXIN B SO4/BACITRACIN (ZINC)/
NEOMYCIN SO4/HYDROCORTISONE
10000U/400U/5MG/10MG PER G OPHTHALMIC
OINTMENT (3.5G)
00701904
CORTISPORIN
136
POLYMYXIN B SO4/NEOMYCIN SO4/DEXAMETHASONE
6,000U/5MG/1MG PER ML OPHTHALMIC SOLUTION
00042676
MAXITROL
ALC
$
2.0659
ALC
$
10.0800
6,000U/5MG/1MG PER G OPHTHALMIC OINTMENT
(3.5G)
00358177
MAXITROL
POLYMYXIN B SO4/NEOMYCIN SO4/HYDROCORTISONE
10,000U/5MG/10MG PER ML EYE/EAR SUSPENSION
02025736
CORTISPORIN
GSK
$
1.2424
SAB
GSK
$
1.0004
1.2424
* 10,000U/5MG/10MG PER ML OTIC SOLUTION
02230386
01912828
CORTIMYXIN
CORTISPORIN
SULFACETAMIDE SODIUM/PREDNISOLONE ACETATE
100MG/2.5MG PER ML OPHTHALMIC SOLUTION
02133342
VASOCIDIN
NVO
$
2.2460
AKN
$
1.2478
ALL
$
12.3200
ALC
$
2.1353
ALC
$
11.0700
APX
$
0.1015
WYA
$
0.7567
ALC
$
3.4069
100MG/5MG PER ML OPHTHALMIC SUSPENSION
02023814
DIOPTIMYD
100MG/2MG PER G OPHTHALMIC OINTMENT
(3.5G)
00307246
BLEPHAMIDE S.O.P.
TOBRAMYCIN/DEXAMETHASONE
0.3%/0.1% OPHTHALMIC SUSPENSION
00778907
TOBRADEX (EDS)
0.3%/0.1% OPHTHALMIC OINTMENT (3.5G)
00778915
TOBRADEX (EDS)
52:10.00 CARBONIC ANHYDRASE INHIBITORS
ACETAZOLAMIDE
250MG TABLET
00545015
APO-ACETAZOLAMIDE
500MG SUSTAINED RELEASE CAPSULE
02238073
DIAMOX SEQUELS
BRINZOLAMIDE
1% OPHTHALMIC SUSPENSION
02238873
AZOPT
137
52:10.00 CARBONIC ANHYDRASE INHIBITORS
DORZOLAMIDE HCL
02216205
TRUSOPT
MSD
$
3.5805
ALC
$
0.7307
ALC
$
0.8789
ALC
AKN
$
0.2221
0.2221
ALC
AKN
$
0.2561
0.2561
NVO
ALC
AKN
$
0.2395
0.2894
0.2894
ALC
$
13.5600
ALC
NVO
$
0.5100
0.6185
RTP
PMS
APX
ALL
$
1.0807
1.0807
1.0807
1.7154
52:20.00 MIOTICS
CARBACHOL
00000655
ISOPTO CARBACHOL
00000663
ISOPTO CARBACHOL
PILOCARPINE HCL
00000841
02023725
ISOPTO CARPINE
DIOCARPINE
00000868
02023741
ISOPTO CARPINE
DIOCARPINE
02134896
00000884
02023733
MIOCARPINE
ISOPTO CARPINE
DIOCARPINE
4% OPHTHALMIC GEL (5G)
00575240
PILOPINE-HS
52:24.00 MYDRIATICS
ATROPINE SO4
00035017
01948598
ISOPTO ATROPINE
ATROPINE
DIPIVEFRIN HCL
02032376
02237868
02242232
00529117
RATIO-DIPIVEFRIN
PMS-DIPIVEFRIN
APO-DIPIVEFRIN
PROPINE
138
52:24.00 MYDRIATICS
HOMATROPINE HYDROBROMIDE
00000779
ISOPTO HOMATROPINE
ALC
$
0.6293
ALC
$
0.7487
ALC
$
23.0800
ALC
$
11.9200
ALC
$
2.4456
RTP
ALL
$
2.5064
3.5810
NVO
$
2.5715
MSD
$
5.4250
PMS
RTP
DOM
BOE
$
21.0900
21.0900
22.2000
30.2100
PHU
$
28.2100
00000787
ISOPTO HOMATROPINE
52:36.00 MISCELLANEOUS E.E.N.T. DRUGS
APRACLONIDINE HCL
0.5% OPHTHALMIC SOLUTION (5ML)
02076306
IOPIDINE
1% OPHTHALMIC SOLUTION (1 TREATMENT)
00888354
IOPIDINE
BETAXOLOL HCL
01908448
BETOPTIC S
BRIMONIDINE TARTRATE
02243026
02236876
RATIO-BRIMONIDINE
ALPHAGAN
DICLOFENAC SODIUM
0.1% OPHTHALMIC SOLUTION (ML)
01940414
VOLTAREN OPHTHA (EDS)
DORZOLAMIDE HCL/TIMOLOL MALEATE
2%/0.5% OPHTHALMIC SOLUTION
02240113
COSOPT
IPRATROPIUM BROMIDE
* 21UG/DOSE NASAL SPRAY (PACKAGE)
02239627
02240072
02240508
02163705
PMS-IPRATROPIUM
RATIO-IPRATROPIUM
DOM-IPRATROPIUM
ATROVENT NASAL SPRAY
LATANOPROST
50UG/ML OPHTHALMIC SOLUTION (2.5ML)
02231493
XALATAN
139
LEVOBUNOLOL HCL
02031159
02197456
02241575
02241715
00751286
RATIO-LEVOBUNOLOL
NOVO-LEVOBUNOLOL
APO-LEVOBUNOLOL
SAB-LEVOBUNOLOL
BETAGAN
RTP
NOP
APX
SAB
ALL
$
1.2760
1.2760
1.2760
1.2760
2.3078
SAB
PMS
RTP
NOP
APX
ALL
$
1.6861
1.6872
1.6883
1.6883
1.6883
2.8341
ALL
$
3.2008
NVO
$
18.8300
ALC
$
1.1122
PMS
APX
$
14.9300
14.9300
02241716
02237991
02031167
02197464
02241574
00637661
SAB-LEVOBUNOLOL
PMS-LEVOBUNOLOL
RATIO-LEVOBUNOLOL
NOVO-LEVOBUNOLOL
APO-LEVOBUNOLOL
BETAGAN
LEVOBUNOLOL HCL/DIPIVEFRIN HCL
0.5%/0.1% OPHTHALMIC SOLUTION
02209071
PROBETA
LEVOCABASTINE HYDROCHLORIDE
0.5MG PER ML OPHTHALMIC SUSPENSION (5ML)
02131625
LIVOSTIN
LODOXAMIDE TROMETHAMINE
00893560
ALOMIDE
SODIUM CROMOGLYCATE
* 2% NASAL METERED DOSE MIST (PACKAGE)
01950541
02231390
CROMOLYN
APO-CROMOLYN
140
TIMOLOL MALEATE
00755826
00893773
02048523
02083353
02084317
02166712
02240248
02241731
02238770
APO-TIMOP
GEN-TIMOLOL
NOVO-TIMOL
PMS-TIMOLOL
MED-TIMOLOL
TIMOLOL MALEATE
RATIO-TIMOLOL MALEATE
RHOXAL-TIMOLOL
DOM-TIMOLOL
APX
GPM
NOP
PMS
MED
SAB
RTP
RHO
DOM
$
1.6818
1.6818
1.6818
1.6818
1.6818
1.6818
1.6818
1.6818
1.7664
APX
GPM
PMS
MED
SAB
RTP
RHO
DOM
MSD
$
2.0181
2.0181
2.0181
2.0181
2.0181
2.0181
2.0181
2.1190
3.3874
MSD
$
3.5371
MSD
$
4.2315
00755834
00893781
02083345
02084325
02166720
02240249
02241732
02238771
00451207
APO-TIMOP
GEN-TIMOLOL
PMS-TIMOLOL
MED-TIMOLOL
TIMOLOL MALEATE
RHOXAL-TIMOLOL
DOM-TIMOLOL
TIMOPTIC
0.25% OPHTHALMIC GELLAN SOLUTION
02171880
TIMOPTIC-XE
0.5% OPHTHALMIC GELLAN SOLUTION
02171899
TIMOPTIC-XE
TIMOLOL MALEATE/PILOCARPINE HYDROCHLORIDE
0.5%/2% OPHTHALMIC SOLUTION
01905082
TIMPILO
MSD
$
3.3874
MSD
$
3.3874
ALC
$
28.7600
0.5%/4% OPHTHALMIC SOLUTION
01905090
TIMPILO
TRAVOPROST
0.004% OPHTHALMIC SOLUTION (2.5ML)
02244896
TRAVATAN
141
GASTROINTESTINAL DRUGS
56:00
56:00 GASTROINTESTINAL DRUGS
56:08.00 ANTIDIARRHEA AGENTS
DIPHENOXYLATE HCL
2.5MG TABLET
00036323
LOMOTIL
PHU
$
0.4548
NOP
APX
ICN
PMS
RHO
PMS
DOM
MCL
$
0.2676
0.2676
0.2676
0.2676
0.2676
0.2684
0.2809
0.7758
PMS
PMS
$
0.0911
0.0912
PMS
$
0.0158
RTP
APX
$
0.0158
0.0158
LOPERAMIDE HCL
* 2MG CAPLET
02132591
02212005
02228343
02228351
02233998
02229552
02239535
02183862
NOVO-LOPERAMIDE
APO-LOPERAMIDE
LOPERACAP
PMS-LOPERAMIDE
RHOXAL-LOPERAMIDE
DIARR-EZE
DOM-LOPERAMIDE
IMODIUM
* 0.2MG/ML ORAL SOLUTION
02192667
02016095
DIARR-EZE
PMS-LOPERAMIDE HCL
56:12.00 CATHARTICS AND LAXATIVES
LACTULOSE
667MG/ML SYRUP
00703486
PMS-LACTULOSE (EDS)
* 667MG/ML SOLUTION
00854409
02242814
RATIO-LACTULOSE (EDS)
APO-LACTULOSE (EDS)
144
56:16.00 DIGESTANTS
PANCRELIPASE (LIPASE/AMYLASE/PROTEASE)
4000U/12000U/12000U CAPSULE CONTAINING
ENTERIC COATED PARTICLES
00789445
PANCREASE MT 4
JAN
$
0.3733
JAN
$
0.3727
AXC
$
0.2214
SLV
$
0.1812
ORG
$
0.2670
ORG
$
0.3662
JAN
$
0.9329
SLV
$
0.2897
AXC
$
0.4330
JAN
$
1.4925
ORG
$
0.9456
AXC
$
0.7503
SLV
$
0.8597
02242374
PANCREASE
02203324
ULTRASE MS4
02239007
CREON 5
8000U/30000U/30000U CAPSULE
00263818
COTAZYM
00502790
COTAZYM ECS 8
00789437
PANCREASE MT 10
02200104
CREON 10
02045834
ULTRASE MT12
00789429
PANCREASE MT 16
00821373
COTAZYM ECS 20
02045869
ULTRASE MT20
02239008
CREON 20
145
56:16.00 DIGESTANTS
01985205
CREON 25
SLV
$
0.9049
AXC
$
0.2303
AXC
$
0.3470
AXC
$
0.4951
APX
NOP
HOR
$
0.0147
0.0408
0.1313
HOR
$
0.0740
SAB
HOR
$
3.2600
4.4100
HOR
$
0.5100
HOR
$
0.5328
DUI
$
1.3020
PFC
$
0.4557
NVR
$
4.1800
8000U/30000U/30000U TABLET
02230019
VIOKASE
16000U/60000U/60000U TABLET
02241933
VIOKASE
24000U/100000U/100000U POWDER
02230020
VIOKASE
56:22.00 ANTI-EMETICS
DIMENHYDRINATE
* 50MG TABLET
00363766
00021423
00013803
APO-DIMENHYDRINATE
NOVO-DIMENATE
GRAVOL
3MG/ML ORAL LIQUID
00230197
GRAVOL
00392537
00013579
DIMENHYDRINATE IM
GRAVOL
50MG SUPPOSITORY
00013595
GRAVOL
100MG SUPPOSITORY
00013609
GRAVOL
DOXYLAMINE SUCCINATE/PYRIDOXINE HCL
10MG/10MG DELAYED RELEASE TABLET
00609129
DICLECTIN
MECLIZINE HCL
25MG TABLET
00220442
BONAMINE
SCOPOLAMINE
1.5MG TRANSDERMAL THERAPEUTIC SYSTEM
00550094
TRANSDERM-V
146
56:40.00 MISCELLANEOUS GASTROINTESTINAL DRUGS
BUDESONIDE
3MG CONTROLLED ILEAL RELEASE CAPSULE
02229293
ENTOCORT (EDS)
AST
$
1.6058
NXP
APX
RTP
NOP
GPM
PMS
DOM
$
0.0722 *
0.0934
0.0934
0.0934
0.0934
0.0934
0.0980
NXP
RTP
APX
NOP
GPM
PMS
DOM
$
0.1134 *
0.1465
0.1465
0.1465
0.1465
0.1465
0.1539
NXP
RTP
APX
NOP
GPM
PMS
DOM
$
0.1444 *
0.1867
0.1867
0.1867
0.1867
0.1867
0.1960
APX
$
0.1220
DOM
RTP
APX
NOP
NXP
PMS
$
0.1333 *
0.1624
0.1624
0.1624
0.1624
0.1624
CIMETIDINE
* 300MG TABLET
00865818
00487872
00546240
00582417
02227444
02229718
02231287
NU-CIMET
APO-CIMETIDINE
RATIO-PEPTOL
NOVO-CIMETINE
GEN-CIMETIDINE
PMS-CIMETIDINE
DOM-CIMETIDINE
* 400MG TABLET
00865826
00568449
00600059
00603678
02227452
02229719
02231288
NU-CIMET
RATIO-PEPTOL
APO-CIMETIDINE
NOVO-CIMETINE
GEN-CIMETIDINE
PMS-CIMETIDINE
DOM-CIMETIDINE
* 600MG TABLET
00865834
00584282
00600067
00603686
02227460
02229720
02231290
NU-CIMET
RATIO-PEPTOL
APO-CIMETIDINE
NOVO-CIMETINE
GEN-CIMETIDINE
PMS-CIMETIDINE
DOM-CIMETIDINE
60MG/ML ORAL LIQUID
02243085
APO-CIMETIDINE
DOMPERIDONE MALEATE
* 10MG TABLET
02238315
01912070
02103613
02157195
02231477
02236466
DOM-DOMPERIDONE
RATIO-DOMPERIDONE
APO-DOMPERIDONE
NOVO-DOMPERIDONE
NU-DOMPERIDONE
PMS-DOMPERIDONE
147
FAMOTIDINE
* 20MG TABLET
02024195
01953842
02242327
02022133
02196018
02237148
02240622
00710121
NU-FAMOTIDINE
APO-FAMOTIDINE
RATIO-FAMOTIDINE
NOVO-FAMOTIDINE
GEN-FAMOTIDINE
ULCIDINE
RHOXAL-FAMOTIDINE
PEPCID
NXP
APX
RTP
NOP
GPM
ICN
RHO
MSD
$
0.5126 *
0.6398
0.6398
0.6398
0.6398
0.6398
0.6398
1.0153
NXP
APX
NOP
GPM
ICN
RHO
RTP
MSD
$
0.9225 *
1.1514
1.1514
1.1514
1.1514
1.1514
1.1514
1.8461
ABB
$
2.1700
ABB
$
2.1700
ABB
$
79.8600
PMS
$
0.0604
APX
NXP
PMS
$
0.0633
0.0633
0.0633
PMS
$
0.0291
* 40MG TABLET
02024209
01953834
02022141
02196026
02237149
02240623
02242328
00710113
NU-FAMOTIDINE
APO-FAMOTIDINE
NOVO-FAMOTIDINE
GEN-FAMOTIDINE
ULCIDINE
RHOXAL-FAMOTIDINE
RATIO-FAMOTIDINE
PEPCID
LANSOPRAZOLE
15MG DELAYED RELEASE CAPSULE
02165503
PREVACID (EDS)
30MG DELAYED RELEASE CAPSULE
02165511
PREVACID (EDS)
LANSOPRAZOLE/CLARITHROMYCIN/AMOXICILLIN
30MG/500MG/500MG 7-DAY PACKAGE
02238525
HP-PAC (EDS)
METOCLOPRAMIDE HCL
5MG TABLET
02230431
PMS-METOCLOPRAMIDE
* 10MG TABLET
00842834
02143283
02230432
APO-METOCLOP
NU-METOCLOPRAMIDE
PMS-METOCLOPRAMIDE
02230433
PMS-METOCLOPRAMIDE
148
MISOPROSTOL
* 100UG TABLET
02240754
02244022
00813966
NOVO-MISOPROSTOL
APO-MISOPROSTOL
CYTOTEC
NOP
APX
PHU
$
0.2066
0.2066
0.2952
NOP
APX
PMS
PHU
$
0.3440
0.3440
0.3440
0.4914
DOM
PMS
APX
NOP
GPM
PMS
$
0.4764 *
0.5737
0.5737
0.5737
0.5737
0.9106
PMS
APX
NOP
GPM
PMS
$
1.0395
1.0395
1.0395
1.0395
1.6499
PHU
$
0.5176
AST
$
1.8988
AST
$
2.3900
SLV
$
2.0615
JAN
$
0.7053
* 200UG TABLET
02240755
02244023
02244125
00632600
NOVO-MISOPROSTOL
APO-MISOPROSTOL
PMS-MISOPROSTOL
CYTOTEC
NIZATIDINE
* 150MG CAPSULE
02185814
02177714
02220156
02240457
02246046
00778338
DOM-NIZATIDINE
PMS-NIZATIDINE
APO-NIZATIDINE
NOVO-NIZATIDINE
GEN-NIZATIDINE
AXID
* 300MG CAPSULE
02177722
02220164
02240458
02246047
00778346
PMS-NIZATIDINE
APO-NIZATIDINE
NOVO-NIZATIDINE
GEN-NIZATIDINE
AXID
OLSALAZINE SODIUM
250MG CAPSULE
02063808
DIPENTUM
OMEPRAZOLE
10MG DELAYED RELEASE TABLET
02230737
LOSEC (EDS)
02190915
LOSEC (EDS)
PANTOPRAZOLE
40MG ENTERIC TABLET
02229453
PANTOLOC (EDS)
RABEPRAZOLE SODIUM
10MG TABLET
02243796
PARIET (EDS)
149
RANITIDINE
* 150MG TABLET
00865737
00733059
00828564
00828823
02207761
02219077
02242453
02243229
02243038
02212331
NU-RANIT
APO-RANITIDINE
NOVO-RANIDINE
RATIO-RANITIDINE
GEN-RANITIDINE
MED-RANITIDINE
PMS-RANITIDINE
RHOXAL-RANITIDINE
DOM-RANITIDINE
ZANTAC
NXP
APX
NOP
RTP
GPM
MED
PMS
RHO
DOM
GSK
$
0.3513 *
0.4386
0.4386
0.4386
0.4386
0.4386
0.4386
0.4386
0.4605
1.1885
NXP
APX
NOP
RTP
GPM
MED
PMS
RHO
DOM
GSK
$
0.6769 *
0.8449
0.8449
0.8449
0.8449
0.8449
0.8449
0.8449
0.8871
2.2373
GSK
$
0.2023
NXP
NOP
APX
PMS
DOM
AVT
$
0.2557 *
0.3192
0.3192
0.3192
0.3352
0.5578
AVT
$
0.1014
* 300MG TABLET
00865745
00733067
00828556
00828688
02207788
02219085
02242454
02243230
02243039
00641790
NU-RANIT
APO-RANITIDINE
NOVO-RANIDINE
RATIO-RANITIDINE
GEN-RANITIDINE
MED-RANITIDINE
PMS-RANITIDINE
RHOXAL-RANITIDINE
DOM-RANITIDINE
ZANTAC
02212374
ZANTAC
SUCRALFATE
* 1G TABLET
02134829
02045702
02125250
02238209
02239912
02100622
NU-SUCRALFATE
NOVO-SUCRALATE
APO-SUCRALFATE
PMS-SUCRALFATE
DOM-SUCRALFATE
SULCRATE
02103567
SULCRATE SUSPENSION PLUS
150
SULFASALAZINE (SALICYLAZOSULFAPYRIDINE)
* 500MG TABLET
00598461
00685933
02064480
PMS-SULFASALAZINE
RATIO-SULFASALAZINE
SALAZOPYRIN
PMS
RTP
PHU
$
0.0907
0.0907
0.2433
PMS
RTP
ICN
PHU
$
0.1177
0.1177
0.2643
0.3832
FEI
$
0.3339
NOP
PGA
$
0.4297
0.5371
FEI
$
0.6043
AXC
GSK
$
0.5252
0.5934
FEI
$
4.0300
AXC
$
3.8100
FEI
$
4.4200
AXC
$
6.4700
FEI
$
4.8400
AXC
$
0.8348
AXC
$
1.1820
AXC
FEI
$
1.7360
1.7686
00598488
00685925
00445126
02064472
PMS-SULFASALAZINE
RATIO-SULFASALAZINE
S.A.S. 500
SALAZOPYRIN
5-AMINOSALICYLIC ACID
02099675
⌧
PENTASA
400MG ENTERIC COATED TABLET
02171929
01997580
NOVO-5-ASA
ASACOL
02099683
⌧
PENTASA
500MG ENTERIC COATED TABLET
02112787
01914030
SALOFALK
MESASAL
1.0G/100ML RETENTION ENEMA
02153521
PENTASA
2.0G/60G RETENTION ENEMA
02112795
SALOFALK RETENTION ENEMA
02153548
PENTASA
4.0G/60G RETENTION ENEMA
02112809
02153556
PENTASA
250MG SUPPOSITORY
02112752
SALOFALK
500MG SUPPOSITORY
02112760
⌧
SALOFALK
1.0G SUPPOSITORY
02242146
02153564
SALOFALK
PENTASA
151
GOLD COMPOUNDS
60:00
60:00 GOLD COMPOUNDS
60:00.00 GOLD COMPOUNDS
AURANOFIN
AURANOFIN SHOULD BE CONSIDERED ONLY WHEN SALICYLATES OR OTHER
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS, AND, WHEN APPROPRIATE,
STEROIDS, HAVE PROVEN TO BE INADEQUATE FOR CONTROLLING THE
SYMPTOMS OF RHEUMATOID ARTHRITIS. PHYSICIANS PLANNING TO USE
AURANOFIN SHOULD BE EXPERIENCED WITH CHRYSOTHERAPY AND SHOULD
THOROUGHLY FAMILIARIZE THEMSELVES WITH THE TOXICITY AND BENEFITS
OF AURANOFIN. ADVERSE REACTIONS WERE REPORTED IN 62% OF 4,784
PATIENTS TREATED WITH AURANOFIN. MOST COMMON WERE DIARRHEA (47%),
RASH (24%), PRURITIS (17%), ABDOMINAL PAIN (14%), AND STOMATITIS (13%).
POTENTIALLY SERIOUS ADVERSE REACTIONS WERE ANEMIA (1.6%),
LEUKOPENIA (1.9%), THROMBOCYTOPENIA (0.9%) AND PROTEINUREA (5.0%).
3MG CAPSULE
01916823
RIDAURA
PMS
$
1.4034
SAW
$
116.2100
AVT
$
9.7800
AVT
$
11.8700
AVT
$
18.4400
AUROTHIOGLUCOSE
50MG/ML INJECTION SUSPENSION (10ML)
00855774
SOLGANAL
SODIUM AUROTHIOMALATE
01927620
MYOCHRYSINE
01927612
MYOCHRYSINE
01927604
MYOCHRYSINE
154
METAL ANTAGONISTS
64:00
64:00 METAL ANTAGONISTS
64:00.00 METAL ANTAGONISTS
DEFEROXAMINE MESYLATE
* 500MG/VIAL POWDER FOR SOLUTION
02242055
01981242
PMS-DEFEROXAMINE (EDS)
DESFERAL (EDS)
PMS
NVR
$
8.8800
14.1900
PMS
NVR
$
45.5700
56.9700
MSD
$
0.5315
MSD
$
0.7968
HOR
$
0.6838
* 2G/VIAL POWDER FOR SOLUTION
02243450
01981250
DESFERAL (EDS)
PENICILLAMINE
125MG CAPSULE
00497894
CUPRIMINE
250MG CAPSULE
00016055
CUPRIMINE
250MG TABLET
00511641
DEPEN
156
HORMONES AND SUBSTITUTES
68:00
68:00 HORMONES AND SUBSTITUTES
68:04.00 ADRENAL CORTICOSTEROIDS
COMPARABLE ANTI-INFLAMMATORY ACTIVITY OF ORAL
CORTICOSTEROIDS
(MINERALCORTICOID ACTIVITY NOT COMPARABLE)
DURATION OF
ACTION
PRODUCT
COMPARABLE
ANTI-INFLAMMATORY
DOSE
SHORT ACTING
- CORTISONE
- HYDROCORTISONE
- PREDNISONE
- METHYLPREDNISOLONE
INTERMEDIATE ACTING
- TRIAMCINOLONE
LONG ACTING
- DEXAMETHASONE
- BETAMETHASONE
25 mg
20 mg
5 mg
4 mg
4 mg
0.75 mg
0.60 mg
THESE CLASSIFICATIONS ARE IMPORTANT CONSIDERATIONS IN ALTERNATE
DAY STEROID THERAPY.
COMPARABLE ANTI-INFLAMMATORY ACTIVITY OF SOLUBLE
INJECTABLE CORTICOSTEROIDS
PRODUCT
% ACTIVE
BASE
COMPARABLE
ANTI-INFLAMMATORY
DOSE
HYDROCORTISONE
SODIUM SUCCINATE
74.8
100 mg
DEXAMETHASONE
21 PHOSPHATE
76.1
4 mg
158
* 50UG/INHALATION AEROSOL (PACKAGE)
00374407
00872334
VANCERIL INHALER
RATIO-BECLOMETHASONE
SCH
RTP
$
8.1400
8.1400
MDA
$
30.7600
MDA
$
61.5200
SCH
SAB
$
4.2900
4.2900
AST
$
0.4340
AST
$
0.8680
AST
$
1.7360
AST
$
32.0700
AST
$
64.1300
AST
$
115.3900
MSD
$
0.1220
ICN
MSD
$
0.3327
0.4557
50UG/INHALATION AEROSOL (PACKAGE)
(CFC-FREE)
02242029
QVAR
(CFC-FREE)
02242030
QVAR
BETAMETHASONE ACETATE/
BETAMETHASONE SODIUM PHOSPHATE
* 3MG/3MG PER ML INJECTION SUSPENSION (1ML)
00028096
02237835
CELESTONE SOLUSPAN
BETAJECT
BUDESONIDE
0.125MG/ML INHALATION SOLUTION (2ML)
02229099
PULMICORT NEBUAMP
01978918
PULMICORT NEBUAMP
01978926
PULMICORT NEBUAMP
00852074
PULMICORT TURBUHALER
00851752
00851760
CORTISONE ACETATE
5MG TABLET
00016438
CORTONE
* 25MG TABLET
00280437
00016446
CORTISONE
CORTONE
159
DEXAMETHASONE
* 0.5MG TABLET
00295094
01964976
02240684
DEXASONE
PMS-DEXAMETHASONE
RATIO-DEXAMETHASONE
ICN
PMS
RTP
$
0.2138
0.2138
0.2138
DEXASONE
PMS-DEXAMETHASONE
RATIO-DEXAMETHASONE
ICN
PMS
RTP
$
0.4883
0.4883
0.4883
PMS-DEXAMETHASONE
RATIO-DEXAMETHASONE
DEXASONE
PMS
RTP
ICN
$
0.8326
0.8326
0.8329
SAB
CYT
$
9.1700
9.1700
RBP
$
0.2355
GSK
$
14.3300
GSK
GSK
$
23.7700
23.7700
GSK
GSK
$
39.0600
39.0600
GSK
GSK
$
78.1200
78.1200
GSK
$
14.3300
$
23.7700
$
39.0600
$
78.1200
* 0.75MG TABLET
00285471
01964968
02240685
* 4MG TABLET
01964070
02240687
00489158
DEXAMETHASONE 21-PHOSPHATE
00664227
01977547
DEXAMETHASONE SOD PHO INJ
FLUDROCORTISONE ACETATE
0.1MG TABLET
02086026
FLORINEF
02213583
⌧
02213591
02244291
⌧
FLOVENT
FLOVENT HFA
02213605
02244292
⌧
FLOVENT
FLOVENT
FLOVENT HFA
02213613
02244293
FLOVENT
FLOVENT HFA
02237244
FLOVENT DISKUS
02237245
FLOVENT DISKUS
GSK
02237246
FLOVENT DISKUS
GSK
02237247
FLOVENT DISKUS
GSK
160
HYDROCORTISONE
10MG TABLET
00030910
CORTEF
PHU
$
0.1468
PHU
$
0.2653
PHU
$
3.4800
PHU
$
6.0500
PHU
$
0.3529
PHU
$
1.0182
PHU
$
5.1000
PHU
$
9.7700
PMS
AVT
$
0.0832
0.1041
WINPRED
APO-PREDNISONE
ICN
APX
$
0.1123
0.1123
NOVO-PREDNISONE
APO-PREDNISONE
NOP
APX
$
0.0283
0.0283
NOP
APX
$
0.1188
0.1188
STI
$
0.5246
20MG TABLET
00030929
CORTEF
HYDROCORTISONE SODIUM SUCCINATE
100MG INJECTION POWDER
00030600
SOLU-CORTEF
00030619
SOLU-CORTEF
METHYLPREDNISOLONE
4MG TABLET
00030988
MEDROL
16MG TABLET
00036129
MEDROL
METHYLPREDNISOLONE ACETATE
00030759
DEPO-MEDROL
00030767
DEPO-MEDROL
PREDNISOLONE SODIUM PHOSPHATE
02245532
02230619
PMS-PREDNISOLONE
PEDIAPRED
PREDNISONE
* 1MG TABLET
00271373
00598194
* 5MG TABLET
00021695
00312770
* 50MG TABLET
00232378
00550957
NOVO-PREDNISONE
APO-PREDNISONE
TRIAMCINOLONE
4MG TABLET
02194090
ARISTOCORT
161
* 10MG/ML INJECTION SUSPENSION (5ML)
02229540
01999761
KENALOG 10
SAB
WSD
$
12.9400
15.9400
CYT
SAB
WSD
$
5.9700
5.9700
7.4000
STI
$
6.7000
SAW
$
0.7733
SAW
$
1.1474
SAW
$
1.8336
CYT
PHU
$
19.4800
25.1900
THM
$
5.3000
ORG
$
1.0199
* 40MG/ML INJECTION SUSPENSION (1ML)
01977563
02229550
01999869
KENALOG 40
TRIAMCINOLONE HEXACETONIDE
20MG/ML INJECTION SUSPENSION
02194155
ARISTOSPAN (EDS)
68:08.00 ANDROGENS
DANAZOL
50MG CAPSULE
02018144
CYCLOMEN
100MG CAPSULE
02018152
CYCLOMEN
200MG CAPSULE
02018160
CYCLOMEN
TESTOSTERONE CYPIONATE
* 100MG/ML OILY INJECTION SOLUTION (10ML)
01977601
00030783
DEPO-TESTOSTERONE
TESTOSTERONE ENANTHATE
200MG/ML OILY INJECTION SOLUTION (ML)
00029246
DELATESTRYL
TESTOSTERONE UNDECANOATE
40MG CAPSULE
00782327
ANDRIOL
162
68:12.00 CONTRACEPTIVES
ETHINYL ESTRADIOL/D-NORGESTREL
0.05MG/0.25MG (21 TABLET)
02043033
OVRAL
WYA
$
12.6900
WYA
$
12.6900
JAN
ORG
$
12.5300
12.7300
JAN
ORG
$
12.5300
12.7300
PHU
$
12.6600
PHU
$
13.5500
WYA
$
12.4800
WYA
$
12.4800
BEX
WYA
$
11.7000
12.4200
BEX
WYA
$
11.7000
12.4200
WYA
$
12.3600
WYA
$
12.3600
02043041
OVRAL
ETHINYL ESTRADIOL/DESOGESTREL
⌧
02042541
02042487
⌧
ORTHO-CEPT
MARVELON
02042533
02042479
ORTHO-CEPT
MARVELON
ETHINYL ESTRADIOL/ETHYNODIOL DIACETATE
0.03MG/2MG (21 TABLET)
00469327
DEMULEN 30
00471526
DEMULEN 30
ETHINYL ESTRADIOL/L-NORGESTREL
02236974
ALESSE
02236975
⌧
00707600
02043726
⌧
ALESSE
0.03MG/0.05MG(6)0.04MG/0.075MG(5)
0.03MG/0.125MG(10) (21 TABLET)
TRIQUILAR
TRIPHASIL
0.03MG/0.05MG(6)0.04MG/0.075MG(5)
0.03MG/0.125MG(10) INERT TABLETS (7)
(28 TABLET)
00707503
02043734
TRIQUILAR
TRIPHASIL
02042320
MIN-OVRAL
02042339
MIN-OVRAL
163
ETHINYL ESTRADIOL/NORETHINDRONE
⌧
02187086
00317047
⌧
BREVICON
ORTHO 0.5/35
PHU
JAN
$
11.6000
12.5300
PHU
JAN
$
11.6000
12.5300
JAN
$
12.5300
JAN
$
12.5300
PHU
$
11.0900
PHU
$
11.0900
PHU
PHU
JAN
$
7.8400
11.6000
12.5300
PHU
PHU
JAN
$
7.8400
11.6000
12.5300
PFI
$
12.6800
PFI
$
12.6800
PFI
$
12.6800
PFI
$
12.6800
02187094
00340731
BREVICON
ORTHO 0.5/35
0.035MG/0.5MG (7) 0.035MG/0.75MG (7)
0.035/1.0MG (7) (21 TABLET)
00602957
ORTHO 7/7/7
0.035MG/0.5MG (7) 0.035MG/0.75MG (7)
0.035MG/1.0MG (7) INERT TABLETS (7)
(28 TABLET)
00602965
ORTHO 7/7/7
0.035MG/0.5MG(7)0.035MG/1.0MG(9)
0.035MG/0.5MG(5) (21 TABLET)
02187108
SYNPHASIC
0.035MG/0.5MG(7)0.035MG/1.0MG(9)
0.035MG/0.5MG(5) INERT TABLETS (7)
(28 TABLET)
02187116
⌧
02197502
02189054
00372846
⌧
SYNPHASIC
SELECT 1/35
BREVICON 1/35
ORTHO 1/35
02199297
02189062
00372838
SELECT 1/35
BREVICON 1/35
ORTHO 1/35
ETHINYL ESTRADIOL/NORETHINDRONE ACETATE
00315966
MINESTRIN 1/20
00343838
MINESTRIN 1/20
00297143
LOESTRIN 1.5/30
00353027
LOESTRIN 1.5/30
164
ETHINYL ESTRADIOL/NORGESTIMATE
0.035MG/0.18MG (7) 0.035MG/0.215MG (7)
0.035MG/0.25MG (7) (21 TABLET)
02028700
TRI-CYCLEN
JAN
$
12.5300
JAN
$
12.5300
JAN
$
12.5300
JAN
$
12.5300
PAL
$
8.6600
WYA
$
480.0000
BEX
$
314.6500
JAN
$
12.5300
JAN
$
12.5300
0.035MG/0.18MG (7) 0.035MG/0.215MG (7)
0.035MG/0.25MG (7) (28 TABLET)
02029421
TRI-CYCLEN
0.035MG/0.25MG (21 TABLET)
01968440
CYCLEN
0.035MG/0.25MG (28 TABLET)
01992872
CYCLEN
LEVONORGESTREL
0.75MG TABLET
02241674
PLAN B
36MG SUBDERMAL IMPLANTS
02060590
NORPLANT
52MG EXTENDED RELEASE INTRAUTERINE INSERT
02243005
MIRENA
MESTRANOL/NORETHINDRONE
00022608
ORTHO-NOVUM 1/50
NORETHINDRONE
0.35MG (28 TABLET)
00037605
MICRONOR
165
68:16.00 ESTROGENS
⌧
0.3MG TABLET
02230891
02043394
⌧
$
0.0862
0.1151
C.E.S.
PREMARIN
PMS
ICN
WYA
$
0.0814
0.1055
0.1321
ICN
WYA
$
0.2061
0.2750
PMS
ICN
WYA
$
0.1384
0.1877
0.2348
WYA
$
0.3738
0.9MG TABLET
02230892
02043416
⌧
ICN
WYA
0.625MG TABLET
00587281
00265470
02043408
⌧
C.E.S.
PREMARIN
C.E.S.
PREMARIN
1.25MG TABLET
00587303
00265489
02043424
C.E.S.
PREMARIN
0.625MG/G VAGINAL CREAM
02043440
PREMARIN
CONJUGATED ESTROGENS/MEDROXYPROGESTERONE
ACETATE
0.625MG/2.5MG TABLET (PACKAGE)
02242878
PREMPLUS
WYA
$
7.6000
WYA
$
7.6000
ESTRACE
RBP
$
0.1113
ESTRACE
RBP
$
0.2149
ESTRACE
RBP
$
0.3792
SCH
$
19.4800
PHU
$
65.1000
NOO
$
2.3900
0.625MG/5MG TABLET (PACKAGE)
02242879
PREMPLUS
ESTRADIOL
0.5MG TABLET
02225190
1MG TABLET
02148587
2MG TABLET
02148595
0.06% TRANSDERMAL GEL SPRAY (PACKAGE)
02238704
ESTROGEL (EDS)
2MG VAGINAL RING (7.5UG/24 HOURS)
02168898
ESTRING
25UG VAGINAL TABLET
02241332
VAGIFEM
166
68:16.00 ESTROGENS
⌧
25UG TRANSDERMAL THERAPEUTIC SYSTEM (PKG)
00756849
02243722
⌧
19.8000
21.1600
VIVELLE (EDS)
ESTRADOT (EDS)
NVR
NVR
$
19.8000
19.8000
ESTRADERM (EDS)
VIVELLE (EDS)
CLIMARA 50 (EDS)
OESCLIM (EDS)
ESTRADOT (EDS)
NVR
NVR
BEX
PAL
NVR
$
21.1600
21.1600
21.1600
21.1600
21.1600
$
22.7100
22.7100
$
23.8700
23.8700
23.8700
23.8700
02204436
02244001
⌧
$
00756857
02204428
02231509
02243724
02244000
⌧
NVR
PAL
37.5UG TRANSDERMAL THERAPEUTIC SYSTEM (PKG)
02204401
02243999
⌧
ESTRADERM (EDS)
OESCLIM (EDS)
VIVELLE (EDS)
ESTRADOT (EDS)
NVR
NVR
00756792
02204444
02231510
02244002
ESTRADERM (EDS)
VIVELLE (EDS)
CLIMARA 100 (EDS)
ESTRADOT (EDS)
NVR
NVR
BEX
NVR
ESTRADIOL & NORETHINDRONE ACETATE/ESTRADIOL
50UG & 140UG/50UG TRANSDERMAL THERAPEUTIC
SYSTEM (8)
02243529
⌧
ESTALIS-SEQUI (EDS)
NVR
$
22.4100
NVR
NVR
$
22.4100
22.4100
THM
$
17.8600
$
23.6600
$
23.6600
50UG & 250UG/50UG TRANSDERMAL THERAPEUTIC
SYSTEM (8)
02108186
02243530
ESTRACOMB (EDS)
ESTALIS-SEQUI (EDS)
ESTRADIOL VALERATE
10MG/ML OILY INJECTION SUSPENSION (5ML)
00029238
DELESTROGEN
ESTRADIOL/NORETHINDRONE ACETATE
50UG/140UG TRANSDERMAL THERAPEUTIC SYSTEM (8 )
02241835
ESTALIS (EDS)
NVR
50UG/250UG TRANSDERMAL THERAPEUTIC SYSTEM (8 )
02241837
ESTALIS (EDS)
NVR
167
68:16.00 ESTROGENS
ESTROPIPATE (CALCULATED AS SODIUM
ESTRONE SULFATE)
0.625MG TABLET
02089793
OGEN
PHU
$
0.1704
PHU
$
0.3043
PHU
$
0.4811
WEL
$
0.2329
STILBESTROL
WEL
$
0.2821
STILBESTROL
WEL
$
0.3069
LIL
$
1.6926
SRO
$
55.9900
$
19.7300
1.25MG TABLET
02089769
OGEN
2.5MG TABLET
02089777
OGEN
STILBOESTROL
0.1MG TABLET
02091488
STILBESTROL
0.5MG TABLET
02100304
1MG TABLET
02091461
68:16.12 ESTROGEN AGONIST-ANTAGONISTS
RALOXIFENE HCL
60MG TABLET
02239028
EVISTA (EDS)
68:18.00 GONADOTROPINS
CHORIONIC GONADOTROPIN
10000IU/VIAL INJECTION
01925679
PROFASI HP (EDS)
68:20.08 ANTI-DIABETIC DRUGS (INSULINS-PORK)
INSULIN (ISOPHANE) PORK
100U/ML INJECTION SUSPENSION (10ML)
00514551
NPH ILETIN II PORK
LIL
168
68:20.08 ANTI-DIABETIC DRUGS (INSULINS-PORK)
INSULIN (LENTE) PORK
00514535
LENTE ILETIN II, PORK
LIL
$
19.7300
LIL
$
19.7300
LIL
NOO
$
16.2900
16.8400
NOO
LIL
$
33.6700
33.7700
LIL
NOO
$
16.2900
16.8400
NOO
$
24.1200
NOO
$
48.2700
LIL
NOO
$
16.2900
16.8400
NOO
LIL
$
33.6700
33.7700
INSULIN (REGULAR) PORK
100U/ML INJECTION SOLUTION (10ML)
00513644
REGULAR ILETIN II, PORK
68:20.08 ANTI-DIABETIC DRUGS
(INSULINS-HUMAN BIOSYNTHETIC)
INSULIN (ISOPHANE) HUMAN BIOSYNTHETIC
⌧
00587737
02024225
⌧
HUMULIN-N
NOVOLIN GE NPH
100U/ML INJECTION SUSPENSION (5X3ML)
02024268
01959239
NOVOLIN GE NPH PENFILL
HUMULIN-N CARTRIDGE
INSULIN (LENTE) HUMAN BIOSYNTHETIC
⌧
00646148
02024241
HUMULIN-L
NOVOLIN GE LENTE
INSULIN (REGULAR) ASPART
02245397
NOVORAPID (EDS)
100U/ML INJECTION SOLUTION (5X3ML)
02244353
NOVORAPID (EDS)
INSULIN (REGULAR) HUMAN BIOSYNTHETIC
⌧
00586714
02024233
⌧
HUMULIN-R
NOVOLIN GE TORONTO
02024284
01959220
NOVOLIN GE TORONTO PENFIL
HUMULIN-R CARTRIDGE
169
68:20.08 ANTI-DIABETIC DRUGS
(INSULINS-HUMAN BIOSYNTHETIC)
INSULIN (REGULAR) LISPRO
02229704
HUMALOG (EDS)
LIL
$
24.1500
LIL
$
48.3000
02229705
HUMALOG CARTRIDGE (EDS)
INSULIN (REGULAR/ISOPHANE) HUMAN BIOSYNTHETIC
100U/ML INJECTION SUSPENSION 10%/90%
(5X3ML)
02024292
⌧
02024306
01962655
⌧
NOO
$
33.6700
NOVOLIN GE 20/80 PENFILL
HUMULIN 20/80 CARTRIDGE
NOO
LIL
$
33.6700
33.7700
LIL
NOO
$
16.2900
16.8400
NOO
LIL
$
33.6700
33.7700
NOO
$
33.6700
NOO
$
33.6700
LIL
$
48.3000
$
16.2900
16.8400
100U/ML INJECTION SUSPENSION 30%/70% (10ML)
00795879
02024217
⌧
(5X3ML)
HUMULIN 30/70
NOVOLIN GE 30/70
(5X3ML)
02025248
01959212
(5X3ML)
02024314
(5X3ML)
02024322
INSULIN (REGULAR/PROTAMINE) LISPRO
(5X3ML)
02240294
HUMALOG MIX25 (EDS)
INSULIN (ULTRALENTE) HUMAN BIOSYNTHETIC
⌧
00733075
02024276
HUMULIN-U
NOVOLIN GE ULTRALENTE
170
LIL
NOO
68:20.20 ANTI-DIABETIC DRUGS (ORAL HYPOGLYCEMICS)
ACARBOSE
50MG TABLET
02190885
PRANDASE
BAY
$
0.2453
BAY
$
0.3390
APX
$
0.0782
NOP
APX
$
0.0454
0.1075
NU-GLYBURIDE
EUGLUCON
GEN-GLYBE
RATIO-GLYBURIDE
APO-GLYBURIDE
NOVO-GLYBURIDE
MED-GLYBURIDE
PMS-GLYBURIDE
DOM-GLYBURIDE
DIABETA
NXP
PMS
GPM
RTP
APX
NOP
MED
PMS
DOM
AVT
$
0.0342 *
0.0427
0.0427
0.0427
0.0427
0.0427
0.0427
0.0427
0.0449
0.1144
NU-GLYBURIDE
APO-GLYBURIDE
EUGLUCON
GEN-GLYBE
NOVO-GLYBURIDE
MED-GLYBURIDE
PMS-GLYBURIDE
RATIO-GLYBURIDE
DOM-GLYBURIDE
DIABETA
NXP
APX
PMS
GPM
NOP
MED
PMS
RTP
DOM
AVT
$
0.0594 *
0.0741
0.0741
0.0741
0.0741
0.0741
0.0741
0.0743
0.0778
0.2051
100MG TABLET
02190893
PRANDASE
CHLORPROPAMIDE
100MG TABLET
00399302
APO-CHLORPROPAMIDE
* 250MG TABLET
00021350
00312711
NOVO-PROPAMIDE
APO-CHLORPROPAMIDE
GLYBURIDE
* 2.5MG TABLET
02020734
00720933
00808733
01900927
01913654
01913670
02084341
02236733
02234513
02224550
* 5MG TABLET
02020742
01913662
00720941
00808741
01913689
02085887
02236734
01900935
02234514
02224569
171
METFORMIN
* 500MG TABLET
02162822
02167786
02045710
02148765
02223562
02229516
02230670
02233999
02242794
02242974
02229994
02099233
NU-METFORMIN
APO-METFORMIN
NOVO-METFORMIN
GEN-METFORMIN
PMS-METFORMIN
GLYCON
MED-METFORMIN
RHOXAL-METFORMIN
METFORMIN
RATIO-METFORMIN
DOM-METFORMIN
GLUCOPHAGE
NXP
APX
NOP
GPM
PMS
ICN
MED
RHO
ZYP
RTP
DOM
AVT
$
0.1034 *
0.1320
0.1320
0.1320
0.1320
0.1320
0.1320
0.1320
0.1320
0.1320
0.1504
0.2387
NXP
GPM
APX
NOP
PMS
ZYP
DOM
AVT
$
0.1817 *
0.2268
0.2268
0.2268
0.2268
0.2268
0.2382
0.3025
NVR
$
0.5859
NVR
$
0.5859
NVR
$
0.5859
LIL
$
2.1375
LIL
$
2.9946
LIL
$
4.4834
* 850MG TABLET
02229517
02229656
02229785
02230475
02242589
02242793
02242726
02162849
NU-METFORMIN
GEN-METFORMIN
APO-METFORMIN
NOVO-METFORMIN
PMS-METFORMIN
METFORMIN
DOM-METFORMIN
GLUCOPHAGE
NATEGLINIDE
60MG TABLET
02245438
STARLIX (EDS)
120MG TABLET
02245439
STARLIX (EDS)
180MG TABLET
02245440
STARLIX (EDS)
PIOGLITAZONE HCL
15MG TABLET
02242572
ACTOS (EDS)
30MG TABLET
02242573
ACTOS (EDS)
45MG TABLET
02242574
ACTOS (EDS)
172
REPAGLINIDE
0.5MG TABLET
02239924
GLUCONORM (EDS)
NOO
$
0.2713
GLUCONORM (EDS)
NOO
$
0.2821
GLUCONORM (EDS)
NOO
$
0.2930
AVANDIA (EDS)
GSK
$
1.3346
AVANDIA (EDS)
GSK
$
2.0941
AVANDIA (EDS)
GSK
$
2.9946
APX
$
0.0896
FEI
$
8.4900
AVT
$
45.2200
NVR
$
26.5900
NVR
$
23.0900
1MG TABLET
02239925
2MG TABLET
02239926
ROSIGLITAZONE MALEATE
2MG TABLET
02241112
4MG TABLET
02241113
8MG TABLET
02241114
TOLBUTAMIDE
500MG TABLET
00312762
APO-TOLBUTAMIDE
68:24.00 PARATHYROID
CALCITONIN SALMON
100IU/ML INJECTION (1ML)
02007134
CALTINE 100 (EDS)
200IU/ML INJECTION
01926691
CALCIMAR (EDS)
200IU/DOSE NASAL SPRAY (BOTTLE)
02240775
MIACALCIN (EDS)
68:28.00 PITUITARY AGENTS
COSYNTROPIN ZINC HYDROXIDE
00253952
SYNACTHEN DEPOT
173
68:28.00 PITUITARY AGENTS
DESMOPRESSIN
0.1MG TABLET
00824305
D.D.A.V.P. (EDS)
FEI
$
1.4341
FEI
$
2.8681
FEI
$
10.5300
FEI
$
51.2200
APX
FEI
$
71.7000
102.4300
FEI
$
416.0000
HLR
$
205.9000
HLR
$
396.8000
SRO
$
136.7100
HLR
SRO
LIL
$
195.9000
205.2300
238.3500
LIL
$
303.8300
HLR
$
386.8000
LIL
$
590.2400
0.2MG TABLET
00824143
D.D.A.V.P. (EDS)
4UG/ML INJECTION (1ML)
00873993
D.D.A.V.P. (EDS)
10UG/DOSE INTRANASAL SOLUTION
00402516
D.D.A.V.P. (EDS)
* 10UG/DOSE INTRANASAL SOLUTION (SPRAY PUMP)
02242465
00836362
APO-DESMOPRESSIN (EDS)
D.D.A.V.P. (EDS)
150UG/DOSE INTRANASAL SOLUTION (SPRAY PUMP)
02237860
OCTOSTIM (EDS)
SOMATREM
5MG INJECTION (VIAL)
02204584
PROTROPIN (EDS)
02204576
PROTROPIN (EDS)
SOMATROPIN
3.33MG INJECTION (VIAL)
02215136
⌧
SAIZEN (EDS)
02216183
02237971
00745626
NUTROPIN (EDS)
SAIZEN (EDS)
HUMATROPE (EDS)
6MG INJECTION (CARTRIDGE)
02243077
HUMATROPE CARTRIDGE (EDS)
02229722
NUTROPIN AQ (EDS)
12MG INJECTION (CARTRIDGE)
02243078
174
68:32.00 PROGESTINS
CONJUGATED ESTROGENS/MEDROXYPROGESTERONE
ACETATE
SEE SECTION 68:16.00 (ESTROGENS)
ESTRADIOL & NORETHINDRONE ACETATE/ESTRADIOL
ESTRADIOL/NORETHINDRONE ACETATE
MEDROXYPROGESTERONE ACETATE
* 2.5MG TABLET
02148552
02221284
02244726
02229838
00708917
RATIO-MPA
NOVO-MEDRONE
APO-MEDROXY
GEN-MEDROXY
PROVERA
RTP
NOP
APX
GPM
PHU
$
0.0862
0.0862
0.0862
0.0889
0.1670
RATIO-MPA
NOVO-MEDRONE
APO-MEDROXY
GEN-MEDROXY
PROVERA
RTP
NOP
APX
GPM
PHU
$
0.1703
0.1703
0.1703
0.1758
0.3303
RTP
NOP
GPM
PHU
$
0.3439
0.3439
0.3548
0.6702
PHU
$
25.2400
PHU
$
27.0800
SCH
$
0.6970
* 5MG TABLET
02148560
02221292
02244727
02229839
00030937
* 10MG TABLET
02148579
02221306
02229840
00729973
RATIO-MPA
NOVO-MEDRONE
GEN-MEDROXY
PROVERA
00030848
DEPO-PROVERA
00585092
DEPO-PROVERA
PROGESTERONE (MICRONIZED)
100MG CAPSULE
02166704
PROMETRIUM (EDS)
175
68:36.04 THYROID AGENTS
LEVOTHYROXINE (SODIUM)
0.025MG TABLET
02172062
SYNTHROID
ABB
$
0.0782
GSK
ABB
$
0.0431
0.0574
ABB
$
0.0843
ABB
$
0.0843
GSK
ABB
$
0.0332
0.0708
ABB
$
0.0890
ABB
$
0.0901
GSK
ABB
$
0.0369
0.0758
ABB
$
0.0966
GSK
ABB
$
0.0391
0.0809
GSK
ABB
$
0.0934
0.1116
THM
$
0.1047
THM
$
0.1270
PFI
$
0.0384
PFI
$
0.0478
PFI
$
0.0609
* 0.05MG TABLET
02213192
02172070
ELTROXIN
SYNTHROID
0.075MG TABLET
02172089
SYNTHROID
0.088MG TABLET
02172097
SYNTHROID
* 0.1MG TABLET
02213206
02172100
ELTROXIN
SYNTHROID
0.112MG TABLET
02171228
SYNTHROID
0.125MG TABLET
02172119
SYNTHROID
* 0.15MG TABLET
02213214
02172127
ELTROXIN
SYNTHROID
0.175MG TABLET
02172135
SYNTHROID
* 0.2MG TABLET
02213222
02172143
ELTROXIN
SYNTHROID
* 0.3MG TABLET
02213230
02172151
ELTROXIN
SYNTHROID
LIOTHYRONINE (SODIUM)
5UG TABLET
01919458
CYTOMEL
25UG TABLET
01919466
CYTOMEL
THYROID
30MG TABLET
00023949
THYROID
60MG TABLET
00023957
THYROID
125MG TABLET
00023965
THYROID
176
68:36.08 ANTITHYROID AGENTS
METHIMAZOLE
5MG TABLET
00015741
TAPAZOLE
PMS
$
0.1305
PMS
$
0.1277
PMS
$
0.1999
PROPYLTHIOURACIL
50MG TABLET
00010200
PROPYL-THYRACIL
100MG TABLET
00010219
PROPYL-THYRACIL
177
SKIN AND MUCOUS MEMBRANE
PREPARATIONS
84:00
84:00 SKIN AND MUCOUS MEMBRANE PREPARATIONS
CLINDAMYCIN PHOSPHATE
1% TOPICAL SOLUTION
00582301
DALACIN T
PHU
$
0.3068
WSD
$
0.1666
GAC
$
0.1549
WSD
$
0.1666
WSD
$
0.1666
AVT
$
1.0254
AVT
$
2.9784
FUCIDIN
LEO
$
0.6258
BACTROBAN
GSK
$
0.5512
GSK
$
0.5512
ERYTHROMYCIN/ETHYL ALCOHOL
1.5%/55% TOPICAL LOTION
01910086
STATICIN
2%/44% TOPICAL LOTION
01902628
SANS-ACNE
2%/71.2% TOPICAL LOTION
02047802
T-STAT
2%/71.2% TOPICAL LOTION/PRE-MOISTENED PADS
02047799
T-STAT
FRAMYCETIN SO4
1% GAUZE (10CM X 10CM)
01988840
SOFRA-TULLE
1% GAUZE (30CM X 10CM)
01987682
SOFRA-TULLE
FUSIDIC ACID
2% TOPICAL CREAM
00586668
MUPIROCIN
2% CREAM
02239757
2% OINTMENT
01916947
BACTROBAN
POLYMYXIN B SO4/NEOMYCIN SO4/BACITRACIN(ZINC)
* 5,000U/5MG/400U PER G TOPICAL OINTMENT
00653268
00666122
RATIO-NEOTOPIC
NEOSPORIN
RTP
GSK
$
0.3502
0.4449
GSK
$
0.4449
LEO
$
0.6258
POLYMYXIN B SO4/NEOMYCIN SO4/GRAMICIDIN
10,000U/5MG/0.25MG PER G TOPICAL CREAM
00666203
NEOSPORIN
SODIUM FUSIDATE
2% TOPICAL OINTMENT
00586676
FUCIDIN
180
84:04.08 ANTI-INFECTIVES (ANTI-FUNGALS)
CICLOPIROX OLAMINE
1% TOPICAL CREAM
02221802
LOPROX
AVT
$
0.5968
AVT
$
0.5498
BCD
$
12.7300
TAR
BCD
$
0.2279
0.3596
TAR
BCD
$
0.1899
0.2331
TAR
BCD
$
0.3798
0.4662
BCD
$
12.7300
WSD
$
6.0689
WSD
$
0.4630
OPT
MCL
$
0.3437
0.4915
1% TOPICAL LOTION
02221810
LOPROX
CLOTRIMAZOLE
200MG VAGINAL TABLET
02150921
CANESTEN-3-COMBI-PAK
* 1% TOPICAL CREAM
00812382
02150867
CLOTRIMADERM
CANESTEN
* 1% VAGINAL CREAM
00812366
02150891
CLOTRIMADERM
CANESTEN-6
* 2% VAGINAL CREAM
00812374
02150905
CLOTRIMADERM
CANESTEN-3
500MG VAGINAL SUPPOSITORY/1% TOPICAL CREAM
(COMBINATION PACKAGE)
02150948
ECONAZOLE NITRATE
150MG VAGINAL SUPPOSITORY
02010267
ECOSTATIN
1% TOPICAL CREAM
02011948
ECOSTATIN
KETOCONAZOLE
* 2% TOPICAL CREAM
02245662
00703974
KETODERM
NIZORAL
181
MICONAZOLE NITRATE
02084295
MONISTAT-7
MCL
$
1.6400
MCL
$
13.1300
VTH
MCL
$
2.0398
3.8265
MCL
$
13.1300
MCL
$
0.3280
MCL
$
0.3668
RTP
$
0.1519
TAR
RTP
PPZ
$
0.0760
0.1269
0.3038
TAR
RTP
$
0.1556
0.1556
TAR
PPZ
$
0.0534
0.0955
RTP
$
0.2774
WSD
$
0.4022
NVR
$
0.4883
NVR
$
0.4883
100MG VAGINAL SUPPOSITORY/2% TOPICAL CREAM
02126257
MONISTAT 7 COMBINATION
* 400MG VAGINAL OVULES
02171775
02126605
MICONAZOLE 3 DAY OVULE
MONISTAT-3
400MG VAGINAL OVULES/2% TOPICAL CREAM
02126249
2% VAGINAL CREAM
02084309
MONISTAT-7
2% TOPICAL CREAM
02085852
MICATIN
NYSTATIN
100,000U VAGINAL TABLET
02194171
RATIO-NYSTATIN
* 100,000U/G TOPICAL CREAM
00716871
02194236
00029092
NYADERM
RATIO-NYSTATIN
MYCOSTATIN
* 100,000U/G TOPICAL OINTMENT
00716898
02194228
NYADERM
RATIO-NYSTATIN
* 25,000U/G VAGINAL CREAM
00716901
00295973
NYADERM
MYCOSTATIN
100,000U/G VAGINAL CREAM
02194163
RATIO-NYSTATIN
100,000U/G TOPICAL POWDER
02195704
CANDISTATIN
TERBINAFINE HCL
1% TOPICAL CREAM
02031094
LAMISIL
1% TOPICAL SPRAY SOLUTION
02238703
LAMISIL
182
TERCONAZOLE
80MG VAGINAL OVULES
00894710
TERAZOL-3
JAN
$
6.3364
JAN
$
19.0100
JAN
$
19.0100
JAN
$
19.0100
80MG VAGINAL OVULES/0.8% CREAM (DUAL-PAK)
02130874
TERAZOL-3 DUAL-PAK
0.4% VAGINAL CREAM (PKG)
00894729
TERAZOL-7
0.8% VAGINAL CREAM (PKG)
01934155
TERAZOL-3
84:04.12 ANTI-INFECTIVES (SCABICIDES AND PEDICULICIDES)
CROTAMITON
10% TOPICAL CREAM
00623377
EURAX
CLC
$
0.4471
MED
$
17.3600
PMS
$
0.0999
ODN
PMS
$
0.0999
0.0999
PFC
GCH
$
0.1129
0.1129
GSK
$
0.4991
GCH
$
0.2843
GCH
$
0.1027
ESDEPALLATHRIN/PIPERONYL BUTOXIDE
0.63%/5.04% AEROSOL
02229874
SCABENE
GAMMA-BENZENE HEXACHLORIDE
1% TOPICAL LOTION
00703591
PMS-LINDANE
* 1% SHAMPOO
00430617
00703605
HEXIT SHAMPOO
PMS-LINDANE
PERMETHRIN
* 1% CREME RINSE
00771368
02231480
NIX CREME RINSE
KWELLADA-P CREME RINSE
5% TOPICAL CREAM
02219905
NIX DERMAL CREAM
5% TOPICAL LOTION
02231348
KWELLADA-P LOTION
PYRETHINS/PIPERONYL BUTOXIDE/
PETROLEUM DISTILLATE
0.33%/3.0%/1.2% SHAMPOO/CONDITIONER
02125447
R&C SHAMPOO/CONDITIONER
183
HEXACHLOROPHENE
3% TOPICAL EMULSION
02017733
PHISOHEX
SAW
$
0.0620
GAC
$
0.6304
GAC
$
0.5354
DER
$
0.5357
STI
$
0.5357
MDA
$
0.2752
RHO
$
0.2189
PFR
$
0.7751
PFR
$
0.1054
PFR
$
0.0456
$
0.5074
$
0.3045
METRONIDAZOLE
0.75% TOPICAL GEL
02092832
METROGEL
0.75% TOPICAL CREAM
02226839
METROCREAM
1% TOPICAL CREAM
02156091
NORITATE
1% TOPICAL CREAM (WITH SUNSCREEN)
02242919
ROSASOL
0.75% VAGINAL GEL
02125226
NIDAGEL
10% VAGINAL CREAM
01926861
FLAGYL
POVIDONE-IODINE
00026050
BETADINE
10% VAGINAL GEL
00026034
BETADINE
10% VAGINAL SOLUTION
00026093
BETADINE
SULFACETAMIDE (SODIUM)/COLLOIDAL SULPHUR
02220407
SULFACET-R
DER
SULFANILAMIDE/AMINACRINE HCL/ALLANTOIN
15%/0.2%/2% VAGINAL CREAM
02103036
AVC
THM
SEE INSERT THIS SECTION FOR TABLES SHOWING APPROXIMATE
RELATIVE POTENCIES OF TOPICAL STEROID PREPARATIONS, RELATIVE
RATES OF PENETRATION IN DIFFERENT ANATOMICAL SITES AND
SUGGESTED GUIDELINES FOR TOPICAL STEROID THERAPY
184
GUIDELINES FOR TOPICAL STEROID THERAPY
1.
Apply an appropriately potent compound to bring
the condition under control.
2.
Continue treatment, with a less potent preparation
after control is achieved.
3.
Reduce the frequency of application.
4.
If required, continue application with the weakest
preparation that will control the condition.
5.
Once healed, "tail off" treatment.
6.
Use special care in treating children, the elderly,
and in certain anatomical sites (e.g. face and
flexures).
7.
Use combination products (those containing antiinfective agents) only for short periods of time.
185
APPROXIMATE
RELATIVE POTENCIES
of
TOPICAL STEROID
PREPARATIONS
The classification of products in this table is based on 'WHO Model
Prescribing Information: Drugs Used in Dermatology (1995)'. Comments
from Saskatchewan Dermatologists have been incorporated.
In general, ointments, as a result of their more occlusive property, tend to
exhibit higher potency than creams of the same strength. Cream
formulations, in turn, appear to be more potent than lotions containing the
same concentration of the same anti-inflammatory agent.
186
ULTRA
HIGH
POTENCY
HIGH
POTENCY
GROUP
I
Betamethasone dipropionate 0.05% glycol cream, ointment, lotion
Betamethasone dipropionate 0.05%/salicylic acid 3% ointment
Clobetasol propionate 0.05% cream, ointment, scalp lotion
Diflorasone diacetate 0.05% ointment
Halobetasol propionate 0.05% ointment
GROUP
II
Amcinonide 0.1% ointment
Betamethasone dipropionate 0.05% ointment
Desoximetasone 0.25% cream, ointment
Desoximetasone 0.5% gel
Fluocinonide 0.05% cream, ointment, gel, emollient base
Halcinonide 0.1% cream, ointment, solution
Halobetasol propionate 0.05% cream
GROUP
III
Betamethasone dipropionate 0.05% cream
Betamethasone valerate 0.1% ointment
Diflorasone diacetate 0.05% cream
Triamcinolone acetonide 0.1% ointment
GROUP
IV
MID
POTENCY
GROUP
V
GROUP
VI
LOW
POTENCY
GROUP
VII
Amcinonide 0.1% cream, lotion
Beclomethasone dipropionate 0.025% cream, lotion
Desoximetasone 0.05% cream
Fluocinolone acetonide 0.025% ointment
Hydrocortisone valerate 0.2% ointment
Mometasone furoate 0.1% cream, ointment, lotion
Triamcinolone acetonide 0.1% cream
Betamethasone benzoate 0.025% gel
Betamethasone valerate 0.1% cream, lotion
Betamethasone valerate 0.05% cream, ointment, lotion
Fluocinolone acetonide 0.01% cream, ointment, solution
Fluocinolone acetonide 0.025% cream
Hydrocortisone valerate 0.2% cream
Triamcinolone acetonide 0.025% cream, ointment
Desonide 0.05% cream, ointment, lotion
Hydrocortisone
0.5% lotion
1% cream, ointment, lotion
2.5% cream, lotion, scalp solution
Methylprednisolone 0.25% ointment
187
RELATIVE RATES OF PERCUTANEOUS PENETRATION IN
DIFFERENT ANATOMICAL SITES
(Based on hydrocortisone/forearm = 1)
RELATIVE
PENETRATION
0.14
0.83
1.0
1.7
3.5
6.0
13.0
42.0
SITE
Foot (plantar)
Palm
Forearm
Back
Scalp
Forehead
Jaw angle/cheeks
Scrotum
Arndt, K.A., Manual of Dermatological
Therapeutics, 2nd Edition, p. 293
GUIDE TO TOPICAL QUANTITIES IN DERMATOLOGY
Amount used three times daily for one week, average adult.
SITE
% BODY
SURFACE
VANISHING
CREAM
GREASE
BASE
SHAKE
LOTION
THIN
(NON SHAKE
LOTION)
PROPYLENE
GLYCOL
ONE WHOLE
HAND or
FOOT
2%
7.5g
10g
20mL
5mL
15mL
ONE WHOLE
ARM
9%
30g
45g
90mL
24mL
60mL
TRUNK
36%
120g
180g
360mL
90mL
240mL
GENITAL
AREA
1%
7.5g
5g
not used
here
5mL
7.5mL
ONE TOTAL
LEG
18%
60g
90g
180mL
45mL
120mL
TOTAL FACE
4.5%
15g
20g
40mL
10mL
30mL
BODY
100%
375g
500g
1000mL
240mL
750mL
188
AMCINONIDE
0.1% TOPICAL CREAM
02192284
CYCLOCORT
STI
$
0.5585
STI
$
0.5585
STI
$
0.4693
RBP
$
0.6431
RBP
$
0.3961
0.1% TOPICAL OINTMENT
02192268
CYCLOCORT
0.1% TOPICAL LOTION
02192276
CYCLOCORT
0.025% TOPICAL CREAM
02089602
PROPADERM
0.025% TOPICAL LOTION
02089610
PROPADERM
BETAMETHASONE DIPROPIONATE
PENETRATION OF ACTIVE DRUG THROUGH THE EPIDERMIS IS ENHANCED
BY THE PROPYLENE GLYCOL BASE, RESULTING IN INCREASED POTENCY,
BECAUSE OF THE DIFFERENCE IN POTENCY YET SIMILARITY OF THE NAMES
(DIPROSONE-DIPROLENE) EXTRA CAUTION IS ADVISED.
* 0.05% TOPICAL CREAM
00323071
01925350
DIPROSONE
TARO-SONE
SCH
TAR
$
0.2337
0.2337
SCH
RTP
$
0.2337
0.2337
SCH
RTP
TAR
$
0.2149
0.2149
0.2149
SCH
RTP
$
0.5628
0.5628
SCH
RTP
$
0.5628
0.5628
SCH
RTP
$
0.5083
0.5083
* 0.05% TOPICAL OINTMENT
00344923
00805009
DIPROSONE
RATIO-TOPISONE
* 0.05% TOPICAL LOTION
00417246
00809187
01944444
DIPROSONE
RATIO-TOPISONE
TARO-SONE
* 0.05% TOPICAL GLYCOL CREAM
00688622
00849650
DIPROLENE
RATIO-TOPILENE
* 0.05% TOPICAL GLYCOL OINTMENT
00629367
00849669
DIPROLENE
RATIO-TOPILENE
* 0.05% TOPICAL GLYCOL LOTION
00862975
01927914
DIPROLENE
RATIO-TOPILENE
189
BETAMETHASONE DIPROPIONATE/
SALICYLIC ACID
0.05%/3% TOPICAL OINTMENT
00578436
DIPROSALIC
SCH
$
0.7697
RTP
SCH
$
0.3824
0.6507
RBP
$
8.6300
SCH
RTP
TAR
$
0.0167
0.0167
0.0167
SCH
RTP
TAR
$
0.0248
0.0248
0.0248
SCH
TAR
$
0.0167
0.0167
SCH
TAR
$
0.0248
0.0248
RTP
$
0.2062
RTP
$
0.2713
SCH
RTP
TAR
$
0.0927
0.0927
0.0927
AST
$
8.3600
* 0.05%/2% TOPICAL LOTION
02245688
00578428
RATIO-TOPISALIC
DIPROSALIC
BETAMETHASONE DISODIUM PHOSPHATE
5MG/100ML ENEMA (100ML)
02060884
BETNESOL ENEMA
BETAMETHASONE VALERATE
00027898
00535427
00716618
CELESTODERM-V/2
RATIO-ECTOSONE
BETADERM
00027901
00535435
00716626
CELESTODERM-V
RATIO-ECTOSONE
BETADERM
00028355
00716642
CELESTODERM-V/2
BETADERM
00028363
00716650
CELESTODERM-V
BETADERM
00653209
RATIO-ECTOSONE MILD
0.1% TOPICAL LOTION
00750050
RATIO-ECTOSONE
* 0.1% SCALP LOTION
00027944
00653217
00716634
VALISONE
RATIO-ECTOSONE
BETADERM
BUDESONIDE
0.02MG/ML ENEMA (100ML)
02052431
ENTOCORT
190
CLOBETASOL PROPIONATE
01910272
02024187
02093162
02232191
02245523
02213265
RATIO-CLOBETASOL
GEN-CLOBETASOL
NOVO-CLOBETASOL
PMS-CLOBETASOL
DERMOVATE
RTP
GPM
NOP
PMS
TAR
OPT
$
0.4414
0.4414
0.4414
0.4414
0.4414
0.8131
GPM
NOP
PMS
TAR
OPT
$
0.4414
0.4414
0.4414
0.4414
0.8131
GPM
PMS
TAR
RTP
OPT
$
0.3868
0.3868
0.3868
0.3871
0.7834
GCH
$
0.4774
GCH
$
0.4774
PMS
GAC
PMS
$
0.2837
0.3147
0.4210
PMS
GAC
PMS
$
0.2837
0.3147
0.4196
GAC
$
0.1574
02026767
02126192
02232193
02245524
02213273
GEN-CLOBETASOL
NOVO-CLOBETASOL
PMS-CLOBETASOL
DERMOVATE
* 0.05% SCALP APPLICATION
02216213
02232195
02245522
01910299
02213281
GEN-CLOBETASOL
PMS-CLOBETASOL
RATIO-CLOBETASOL
DERMOVATE
CLOBETASONE BUTYRATE
0.05% TOPICAL CREAM
02214415
EUMOVATE
02214423
EUMOVATE
DESONIDE
02229315
02048639
02154862
PMS-DESONIDE
DESOCORT
TRIDESILON
02229323
02115522
02154870
PMS-DESONIDE
DESOCORT
TRIDESILON
02115514
DESOCORT
191
DESOXIMETASONE
02239068
02221918
DESOXI
TOPICORT MILD
OPT
AVT
$
0.3022
0.4530
OPT
AVT
$
0.4549
0.6538
OPT
AVT
$
0.3350
0.5371
AVT
$
0.6538
STI
$
0.3943
STI
$
0.3943
STI
$
0.3943
TAR
$
0.0703
TAR
$
0.3364
TAR
MDC
$
0.4676
0.4676
MDC
$
0.4440
HDI
$
0.2681
GAC
$
0.2575
02239069
02221896
DESOXI
TOPICORT
* 0.05% TOPICAL GEL
02241887
02221926
DESOXI
TOPICORT
02221934
TOPICORT
DIFLUCORTOLONE VALERATE
0.1% TOPICAL CREAM
00587826
NERISONE
0.1% TOPICAL OILY CREAM
00587818
NERISONE
00587834
NERISONE
FLUOCINOLONE ACETONIDE
0.01% TOPICAL CREAM
00716782
FLUODERM
00716790
FLUODERM
00716812
02162512
FLUODERM
SYNALAR REGULAR
0.01% TOPICAL SOLUTION
02162504
SYNALAR
0.01% TOPICAL OIL
00873292
DERMA-SMOOTHE/FS
0.01% SHAMPOO
02242738
CAPEX SHAMPOO
192
FLUOCINONIDE
00716863
02161923
LYDERM
LIDEX
OPT
MDC
$
0.5007
0.5010
OPT
MDC
$
0.3711
0.5561
OPT
MDC
$
0.3657
0.5544
MDC
$
0.6041
WSD
$
0.5650
WSD
$
0.5180
WSD
$
0.4356
WSD
$
0.7986
WSD
$
0.7986
VTH
TAR
SCP
$
0.1541
0.1628
0.2438
SCH
TAR
VTH
STI
$
0.0198
0.0198
0.0226
0.1718
STI
$
0.2344
TAR
SCP
$
0.1628
0.2438
* 0.05% TOPICAL GEL
02236997
02161974
LYDERM
TOPSYN
02236996
02161966
LYDERM
LIDEX
0.05% IN EMOLLIENT BASE
02163152
LIDEMOL
HALCINONIDE
0.1% TOPICAL CREAM
02011921
HALOG
02010283
HALOG
02010291
HALOG
HALOBETASOL PROPIONATE
0.05% CREAM
01962701
ULTRAVATE (EDS)
0.05% OINTMENT
01962728
ULTRAVATE (EDS)
HYDROCORTISONE
00228079
00716820
00513288
HYDROCORTISONE CREAM
HYDERM
CORTATE
* 1% TOPICAL CREAM
00502200
00716839
00228087
00192597
CORTATE
HYDERM
EMO-CORT
2.5% TOPICAL CREAM
00595799
EMO-CORT
00716685
00513261
CORTODERM
CORTATE
193
* 1% TOPICAL OINTMENT
00502197
00716693
CORTATE
CORTODERM
SCH
TAR
$
0.0212
0.0212
SCP
$
0.1925
STI
STI
$
0.0938
0.1587
STI
STI
$
0.1812
0.2099
STI
$
0.1985
ICN
AXC
$
5.5800
6.5700
GCH
$
80.5400
WSD
OPT
$
0.1809
0.1809
WSD
OPT
$
0.1809
0.1809
STI
$
0.1747
STI
$
0.0970
SCH
$
0.6938
SCH
$
0.6938
SCH
$
0.5397
0.5% TOPICAL LOTION
00513253
⌧
00578541
00192600
⌧
CORTATE
1% TOPICAL LOTION
SARNA HC
EMO-CORT
2.5% TOPICAL LOTION
00856711
00595802
SARNA HC
EMO-CORT
2.5% SCALP SOLUTION
00641154
EMO-CORT
* 100MG/60ML ENEMA (60ML)
00230316
02112736
HYCORT
CORTENEMA
HYDROCORTISONE ACETATE
10% RECTAL AEROSOL FOAM (15G)
00579335
CORTIFOAM
HYDROCORTISONE VALERATE
01910124
02242984
WESTCORT
HYDROVAL
01910132
02242985
WESTCORT
HYDROVAL
HYDROCORTISONE/UREA
1%/10% TOPICAL CREAM
00503134
UREMOL-HC
00560022
UREMOL-HC
MOMETASONE FUROATE
0.1% TOPICAL CREAM
00851744
ELOCOM
00851736
ELOCOM
0.1% TOPICAL LOTION
00871095
ELOCOM
194
00716952
TRIADERM
TAR
$
0.0504
TAR
STI
WSD
$
0.1411
0.1411
0.3260
TAR
STI
WSD
$
0.1411
0.1411
0.3260
TAR
WSD
$
1.1718
1.3180
SCH
$
0.6706
LEO
$
0.9494
WSD
$
0.5614
TAR
WSD
$
0.4594
0.7943
WSD
$
0.5614
TAR
WSD
$
0.4594
0.7943
00716960
02194058
01999818
TRIADERM
ARISTOCORT R
KENALOG
00716987
02194031
01999796
TRIADERM
ARISTOCORT R
KENALOG
* 0.1% ORAL TOPICAL OINTMENT
01964054
01999788
ORACORT DENTAL PASTE
KENALOG-ORABASE
BETAMETHASONE DIPROPIONATE/CLOTRIMAZOLE
0.05%/1% TOPICAL CREAM
00611174
LOTRIDERM
FUSIDIC ACID/HYDROCORTISONE ACETATE
2%/1% TOPICAL CREAM
02238578
FUCIDIN H
NEOMYCIN/GRAMICIDIN/NYSTATIN/
2.5MG/0.25MG/100,000U/0.25MG PER G
TOPICAL CREAM
01999842
KENACOMB MILD
* 2.5MG/0.25MG/100,000U/1MG PER G
TOPICAL CREAM
00717002
01999850
VIADERM-KC
KENACOMB
2.5MG/0.25MG/100,000U/0.25MG PER G
TOPICAL OINTMENT
01999834
KENACOMB MILD
* 2.5MG/0.25MG/100,000U/1MG PER G
TOPICAL OINTMENT
00717029
01999826
VIADERM-KC
KENACOMB
195
POLYMYXIN B SO4/BACITRACIN (ZINC)/
NEOMYCIN SO4/HYDROCORTISONE
5000U/400U/5MG/10MG PER G TOPICAL OINTMENT
00666246
CORTISPORIN
GSK
$
0.7487
84:08.00 ANTIPRURITICS AND LOCAL ANAESTHETICS
PHENAZOPYRIDINE
* 100MG TABLET
00271489
00476714
PHENAZO
PYRIDIUM
ICN
PFI
$
0.1281
0.1281
ICN
PFI
$
0.1598
0.1775
$
0.7216
GAC
$
0.6272
GAC
$
0.6272
STI
$
0.5968
* 200MG TABLET
00454583
00476722
PHENAZO
PYRIDIUM
84:12.00 ASTRINGENTS
ALUMINUM ACETATE/BENZETHONIUM CHLORIDE
0.35%/0.023% POWDER (2.36G PACKAGE)
00579947
BURO-SOL
STI
84:16.00 CELL STIMULANTS AND PROLIFERANTS
CONDITIONS OTHER THAN ACNE VULGARIS ARE NOT APPROVED
INDICATIONS FOR THE USE OF TOPICAL RETINOIDS.
ADAPALENE
0.1% TOPICAL CREAM
02231592
DIFFERIN
0.1% TOPICAL GEL
02148749
DIFFERIN
ISOTRETINOIN
0.05% TOPICAL GEL
00784338
ISOTREX
196
84:16.00 CELL STIMULANTS AND PROLIFERANTS
TRETINOIN
00657204
01926497
00897329
STIEVA-A
VITAMIN A ACID
RETIN A
STI
DER
JAN
$
0.3082
0.3082
0.3863
STI
DER
JAN
$
0.3082
0.3082
0.3748
STI
DER
JAN
$
0.3082
0.3082
0.3863
STI
DER
JAN
$
0.3082
0.3082
0.3748
STI
$
0.1932
STI
DER
JAN
$
0.3090
0.3090
0.3748
STI
DER
$
0.3082
0.3082
STI
$
0.1932
STI
DER
JAN
$
0.3082
0.3082
0.3863
* 0.01% TOPICAL GEL
00587958
01926462
00870013
STIEVA-A
VITAMIN A ACID
RETIN A
00578576
01926500
00897310
STIEVA-A
VITAMIN A ACID
RETIN A
* 0.025% TOPICAL GEL
00587966
01926470
00443816
STIEVA-A
VITAMIN A ACID
RETIN A
00578568
STIEVA-A
00518182
01926519
00443794
STIEVA-A
VITAMIN A ACID
RETIN A
* 0.05% TOPICAL GEL
00641863
01926489
STIEVA-A
VITAMIN A ACID
00518174
STIEVA-A
00662348
01926527
00870021
STIEVA-A FORTE (EDS)
VITAMIN A ACID (EDS)
RETIN A (EDS)
197
84:28.00 KERATOLYTIC AGENTS
BENZOYL PEROXIDE
10% BAR
00527661
PANOXYL
STI
$
9.1400
ICN
STI
$
0.1677
0.1910
BENOXYL
OXYDERM
STI
ICN
$
0.2122
0.2176
DESQUAM-X
BENZAC W
WSD
GAC
$
0.0543
0.0547
STI
$
0.1492
STI
DER
$
0.1492
0.1511
WSD
GAC
STI
GAC
$
0.1068
0.1453
0.1492
0.1519
STI
$
0.1806
STI
$
0.1945
STI
$
0.1945
STI
$
0.9353
MED
$
0.2437
MED
$
0.2570
MED
$
0.3038
MED
$
0.3318
MED
$
0.3501
* 10% TOPICAL LOTION
00432938
00370568
OXYDERM
BENOXYL
* 20% TOPICAL LOTION
00187585
00374318
⌧
10% WASH
01908901
01925199
10% TOPICAL GEL (ACETONE BASE)
00406848
⌧
00263699
02220385
⌧
ACETOXYL
10% TOPICAL GEL (ALCOHOL BASE)
PANOXYL-10
BENZAGEL
10% TOPICAL GEL (AQUEOUS BASE)
01908871
01925997
02223856
01912437
DESQUAM-X
BENZAC-W
PANOXYL AQUAGEL
BENZAC AC
00403571
PANOXYL-15
00373036
PANOXYL-20
20% TOPICAL GEL (AQUEOUS BASE)
02223864
PANOXYL AQUAGEL
CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE
1%5% TOPICAL GEL
02243158
CLINDOXYL GEL
DITHRANOL
0.1% TOPICAL CREAM
00537594
ANTHRANOL
0.2% TOPICAL CREAM
00537608
ANTHRANOL
0.4% TOPICAL LOTION
00695351
ANTHRASCALP
1% TOPICAL OINTMENT
00566756
ANTHRAFORTE-1
2% TOPICAL OINTMENT
00566748
ANTHRAFORTE-2
198
84:28.00 KERATOLYTIC AGENTS
PODOFILOX
⌧
0.5% TOPICAL SOLUTION (PACKAGE)
02074788
01945149
WARTEC
CONDYLINE
PMS
CDX
$
37.8400
40.1500
84:36.00 MISCELLANEOUS SKIN & MUCOUS MEMBRANE
AGENTS
ACITRETIN
10MG CAPSULE
02070847
SORIATANE (EDS)
HLR
$
1.6782
HLR
$
2.9477
WYA
RTP
DBU
$
0.7636
0.7636
0.7747
LEO
$
0.7568
LEO
$
0.7568
LEO
$
0.7568
25MG CAPSULE
02070863
SORIATANE (EDS)
AMETHOPTERIN
* 2.5MG TABLET
02170698
02244798
02182963
METHOTREXATE
RATIO-METHOTREXATE
METHOTREXATE
CALCIPOTRIOL
50UG/G TOPICAL CREAM
02150956
DOVONEX
50UG/G TOPICAL OINTMENT
01976133
DOVONEX
50UG/ML SCALP SOLUTION
02194341
DOVONEX
CYCLOSPORINE
NOTE: THE IDENTIFICATION NUMBERS LISTED FOR THIS PRODUCT HAVE
BEEN GENERATED BY THE PRESCRIPTION DRUG PLAN FOR BILLING
PURPOSES ONLY.
10MG CAPSULE
00950792
NEORAL (EDS)
NVR
$
0.6637
NVR
$
1.5426
NVR
$
3.0073
NVR
$
6.0164
NVR
$
5.3480
25MG CAPSULE
00950793
NEORAL (EDS)
50MG CAPSULE
00950807
NEORAL (EDS)
100MG CAPSULE
00950815
NEORAL (EDS)
100MG/ML LIQUID
00950823
NEORAL (EDS)
199
84:36.00 MISCELLANEOUS SKIN & MUCOUS MEMBRANE
AGENTS
FLUOROURACIL
5% TOPICAL CREAM
00330582
EFUDEX
ICN
$
0.4601
HLR
$
1.7903
HLR
$
3.6529
FUJ
$
2.3330
FUJ
$
2.4960
ALL
$
1.3961
ALL
$
1.3961
ALL
$
1.3961
ALL
$
1.3961
ISOTRETINOIN
10MG CAPSULE
00582344
ACCUTANE
40MG CAPSULE
00582352
ACCUTANE
TACROLIMUS
02244149
PROTOPIC (EDS)
02244148
PROTOPIC (EDS)
TAZAROTENE
0.05% TOPICAL CREAM
02243894
TAZORAC
0.05% TOPICAL GEL
02230784
TAZORAC
0.1% TOPICAL CREAM
02243895
TAZORAC
0.1% TOPICAL GEL
02230785
TAZORAC
84:50.06 DEPIGMENTING & PIGMENTING AGENTS
(PIGMENTING AGENTS)
METHOXSALEN
⌧
10MG CAPSULE
00252654
00646237
01946374
⌧
OXSORALEN ULTRA (EDS)
ULTRAMOP (EDS)
OXSORALEN (EDS)
ICN
CDX
ICN
$
0.4666
0.5160
0.8181
ULTRAMOP (EDS)
OXSORALEN (EDS)
CDX
ICN
$
1.1198
1.5939
1% LOTION
00698059
01907476
200
SMOOTH MUSCLE RELAXANTS
86:00
86:00 SMOOTH MUSCLE RELAXANTS
86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS
FLAVOXATE HCL
* 200MG TABLET
02244842
00728179
APO-FLAVOXATE (EDS)
URISPAS (EDS)
APX
PMS
$
0.3752
0.5360
NXP
APX
NOP
ICN
GPM
PMS
DOM
JAN
$
0.2067 *
0.2697
0.2697
0.2697
0.2697
0.2697
0.2831
0.4281
PMS
APX
JAN
$
0.0675
0.0675
0.0964
OXYBUTYNIN CHLORIDE
* 5MG TABLET
02158590
02163543
02230394
02220059
02230800
02240550
02241285
01924761
NU-OXYBUTYN
APO-OXYBUTYNIN
NOVO-OXYBUTYNIN
OXYBUTYN
GEN-OXYBUTYNIN
PMS-OXYBUTYNIN
DOM-OXYBUTYNIN
DITROPAN
* 1MG/ML SYRUP
02223376
02231089
01924753
PMS-OXYBUTYNIN
APO-OXYBUTYNIN
DITROPAN
TOLTERODINE L-TARTRATE
Note: Both strengths of Detrol are scheduled to be delisted
from the Saskatchewan Formulary effective April 1, 2003.
1MG TABLET
02239064
DETROL (EDS)
PHU
$
0.9494
DETROL (EDS)
PHU
$
0.9494
PHU
$
1.8988
PHU
$
1.8988
2MG TABLET
02239065
02244612
UNIDET (EDS)
02244613
UNIDET (EDS)
86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS
AMINOPHYLLINE
02014270
PHYLLOCONTIN
PFR
$
0.2158
PFR
$
0.2751
02014289
PHYLLOCONTIN-350
202
86:00 SMOOTH MUSCLE RELAXANTS
86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS
OXTRIPHYLLINE
100MG TABLET
00441724
APO-OXTRIPHYLLINE
APX
$
0.0516
APX
$
0.0733
APX
$
0.1031
PFI
$
0.2453
PFI
$
0.2911
PMS
PFI
$
0.0249
0.0363
APX
NOP
$
0.1411
0.1411
APX
NOP
RIV
AST
$
0.1465
0.1465
0.1978
0.2404
APX
NOP
RIV
BRI
AST
$
0.1519
0.1519
0.2214
0.2811
0.2892
PFR
$
0.4959
PFR
$
0.6005
PMS
$
0.0038
MDA
$
0.0208
200MG TABLET
00441732
APO-OXTRIPHYLLINE
300MG TABLET
00511692
APO-OXTRIPHYLLINE
00503436
CHOLEDYL-SA
00536709
CHOLEDYL-SA
* 20MG/ML ELIXIR
00792942
00476366
PMS-OXTRIPHYLLINE
CHOLEDYL
THEOPHYLLINE (ANHYDROUS)
⌧
00692689
02230085
⌧
00692697
02230086
00631701
00460990
⌧
APO-THEO-LA
NOVO-THEOPHYL SR
APO-THEO-LA
NOVO-THEOPHYL SR
THEOCHRON
THEO-DUR
00692700
02230087
00599905
00556742
00461008
APO-THEO-LA
NOVO-THEOPHYL SR
THEOCHRON
QUIBRON-T/SR
THEO-DUR
02014165
UNIPHYL
02014181
UNIPHYL
5.33MG/ML ELIXIR
00575151
PMS-THEOPHYLLINE
5.33MG/ML SOLUTION
01966219
THEOLAIR LIQUID
203
VITAMINS
88:00
88:00 VITAMINS
88:04.00 VITAMIN A
VITAMIN A IS TOXIC IN EXCESSIVE DOSES
VITAMIN A
25,000IU CAPSULE
00021067
VITAMIN A
NOP
$
0.0586
NOP
$
0.0961
VITAMIN B12
CYANOCOBALAMIN
CYANOCOBALAMIN
SAB
CYT
TAR
$
3.3700
3.3700
3.3700
APO-FOLIC
APX
$
0.0255
WYA
$
5.9024
ICN
$
0.0154
ICN
$
0.0317
ODN
ICN
$
0.0429
0.0495
LEA
ICN
ODN
$
0.0234
0.0280
0.0320
50,000IU CAPSULE
00021075
VITAMIN A
88:08.00 VITAMINS B
CYANOCOBALAMIN
00521515
01987003
02052717
FOLIC ACID
5MG TABLET
00426849
LEUCOVORIN CALCIUM (FOLINIC ACID)
5MG TABLET
02170493
LEUCOVORIN (EDS)
NIACIN
50MG TABLET
00268593
NIACIN
100MG TABLET
00268585
NIACIN
* 500MG TABLET
01939130
00294950
NIACIN
NIACIN
PYRIDOXINE HCL
* 25MG TABLET
00232475
00268607
01943200
PYRIDOXINE HCL
VITAMIN B6
VITAMIN B6
206
88:00 VITAMINS
88:08.00 VITAMINS B
THIAMINE HCL
* 50MG TABLET
00610267
00268631
VITAMIN B1
VITAMIN B1
LEA
ICN
$
0.0192
0.0620
SAB
ABB
$
13.5700
16.2500
LEO
$
0.4438
LEO
$
1.3284
LEO
$
5.0746
SAW
$
0.4202
HLR
$
0.9538
HLR
$
1.5169
HLR
$
3.0380
DPY
$
1.8445
MSD
$
0.2177
00816078
02241983
VITAMIN B1
BETAXIN
88:16.00 VITAMIN D
VITAMIN D IS TOXIC IN EXCESSIVE DOSES
ALFACALCIDOL
0.25UG CAPSULE
00474517
ONE-ALPHA (EDS)
1.0UG CAPSULE
00474525
ONE-ALPHA (EDS)
2UG/ML ORAL DROPS (ML)
02240329
ONE-ALPHA (EDS)
CALCIFEROL
8,288IU/ML ORAL SOLUTION
02017598
DRISDOL
CALCITRIOL
0.25UG CAPSULE
00481823
ROCALTROL (EDS)
0.5UG CAPSULE
00481815
ROCALTROL (EDS)
1UG/ML ORAL SOLUTION
00824291
ROCALTROL (EDS)
DOXERCALCIFEROL
2.5UG CAPSULE
02243790
HECTOROL (EDS)
VITAMIN D
50,000IU CAPSULE
00009830
OSTOFORTE
207
UNCLASSIFIED THERAPEUTIC AGENTS
92:00
92:00 UNCLASSIFIED THERAPEUTIC AGENTS
92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
ALENDRONATE SODIUM
10MG TABLET
02201011
FOSAMAX (EDS)
MSD
$
1.9042
MSD
$
3.8898
MSD
$
9.6030
SAW
$
1.0308
NOP
APX
GSK
$
0.0207
0.0207
0.1102
APX
NOP
GSK
$
0.0363
0.0363
0.1829
NOP
APX
GSK
$
0.0446
0.0446
0.2988
RBP
$
5.0845
GPM
RTP
NOP
APX
GSK
$
0.5879
0.5879
0.5879
0.5879
0.9331
ORP
$
1.4046
40MG TABLET
02201038
FOSAMAX (EDS)
70MG TABLET
02245329
FOSAMAX (EDS)
ALFUZOSIN
10MG PROLONGED-RELEASE TABLET
02245565
XATRAL
ALLOPURINOL
* 100MG TABLET
00364282
00402818
00004588
NOVO-PUROL
APO-ALLOPURINOL
ZYLOPRIM
* 200MG TABLET
00479799
00565342
00506370
APO-ALLOPURINOL
NOVO-PUROL
ZYLOPRIM
* 300MG TABLET
00363693
00402796
00294322
NOVO-PUROL
APO-ALLOPURINOL
ZYLOPRIM
ANAGRELIDE HCL
0.5MG CAPSULE
02236859
AGRYLIN
AZATHIOPRINE
* 50MG TABLET
02231491
02236799
02236819
02242907
00004596
GEN-AZATHIOPRINE
RATIO-AZATHIOPRINE
NOVO-AZATHIOPRINE
APO-AZATHIOPRINE
IMURAN
BETAINE ANHYDROUS
1G/SCOOP POWDER FOR ORAL SOLUTION
02238526
CYSTADANE
210
BOSENTAN
62.5MG TABLET
02244981
TRACLEER (EDS)
ACT
$
60.4000
ACT
$
60.4000
ALL
$
3.6890
APX
PMS
NVR
$
1.0537
1.0537
1.6726
APX
PMS
DOM
NVR
$
0.5917
0.5917
0.6213
0.9391
AVT
$
101.7200
AVT
$
68.1400
PHU
$
13.7253
COLCHICINE-ODAN
ODN
$
0.2116
COLCHICINE-ODAN
ODN
$
0.4102
125MG TABLET
02244982
TRACLEER (EDS)
BOTULINUM TOXIN TYPE A
100IU STERILE LYOPHILIZED POWDER (IU)
01981501
BOTOX (EDS)
BROMOCRIPTINE MESYLATE
* 5MG CAPSULE
02230454
02236949
00568643
APO-BROMOCRIPTINE
PMS-BROMOCRIPTINE
PARLODEL
* 2.5MG TABLET
02087324
02231702
02238636
00371033
APO-BROMOCRIPTINE
PMS-BROMOCRIPTINE
DOM-BROMOCRIPTINE
PARLODEL
BUSERELIN ACETATE
1.05MG/ML INJECTION (2)
02225166
SUPREFACT (EDS)
1.05MG/ML INTRANASAL SOLUTION
02225158
SUPREFACT (EDS)
CABERGOLINE
0.5MG TABLET
02242471
DOSTINEX (EDS)
COLCHICINE
0.6MG TABLET
00572349
1MG TABLET
00621374
211
CYCLOSPORINE (TRANSPLANT)
10MG CAPSULE
02237671
NEORAL (EDS)
NVR
$
0.6637
NVR
$
1.5426
NVR
$
3.0073
NVR
$
6.0164
NVR
$
5.3480
PFI
$
4.7849
PFI
$
4.7849
NVR
$
1.5190
WYA
$
172.5000
PGA
$
1.4224
PGA
$
39.8200
MSD
$
1.7686
25MG CAPSULE
02150689
NEORAL (EDS)
50MG CAPSULE
02150662
NEORAL (EDS)
100MG CAPSULE
02150670
NEORAL (EDS)
100MG/ML LIQUID
02150697
NEORAL (EDS)
DONEPEZIL HCL
5MG TABLET
02232043
ARICEPT (EDS)
10MG TABLET
02232044
ARICEPT (EDS)
ENTACAPONE
200MG TABLET
02243763
COMTAN
ETANERCEPT
25MG/VIAL POWDER FOR INJECTION (VIAL)
02242903
ENBREL (EDS)
ETIDRONATE DISODIUM
200MG TABLET
01997629
DIDRONEL (EDS)
ETIDRONATE DISODIUM/CALCIUM CARBONATE
400MG/1250MG TABLET (PACKAGE)
02176017
DIDROCAL
FINASTERIDE
5MG TABLET
02010909
PROSCAR
212
GALANTAMINE HYDROBROMIDE
4MG TABLET
02244298
REMINYL (EDS)
JAN
$
2.4901
REMINYL (EDS)
JAN
$
2.4901
JAN
$
2.4901
TVM
$
34.6900
TVM
$
37.0000
LIL
$
35.6500
LIL
$
89.1800
AST
$
411.7500
8MG TABLET
02244299
12MG TABLET
02244300
REMINYL (EDS)
GLATIRAMER ACETATE
SEE APPENDIX J FOR EDS CRITERIA
02233014
COPAXONE (EDS)
20MG INJECTION (PRE-FILLED SYRINGE)
02245619
COPAXONE (EDS)
GLUCAGON
00015377
GLUCAGON
1MG INJECTION POWDER (RDNA ORIGIN)
02243297
GLUCAGON
GOSERELIN ACETATE
3.6MG/SYRINGE
02049325
ZOLADEX (EDS)
INFLIXIMAB
WHEN BILLING, SUBMIT QUANTITY IN TERMS OF MILLIGRAMS.
NOTE: THE IDENTIFICATION NUMBER LISTED FOR THIS PRODUCT HAS
BEEN GENERATED BY THE PRESCRIPTION DRUG PLAN FOR BILLING
PURPOSES ONLY.
100MG/VIAL INJECTION (MG) (CROHN'S DISEASE)
00950899
REMICADE (EDS)
SCH
$
11.8000
SCH
$
11.8000
$
861.1800
$
861.1800
100MG/VIAL INJECTION (MG) (RHEUMATOID
ARTHRITIS)
02244016
REMICADE (EDS)
INTERFERON ALFA-2B/RIBAVIRIN
6 MILLION IU/ML (0.5ML) INJECTION SOLUTION
ALBUMIN (HUMAN) FREE/200MG CAPSULE (PACKAGE)
02239730
REBETRON (EDS)
SCH
15 MILLION IU/ML MULTI-DOSE PEN
ALBUMIN (HUMAN) FREE/200MG CAPSULE (PACKAGE)
02241159
REBETRON (EDS)
SCH
213
INTERFERON BETA-1A
22UG (6 MILLION IU) PRE-FILLED SYRINGE
02237319
REBIF (EDS)
SRO
$
118.2700
SRO
$
145.0000
BGN
$
330.5800
BEX
$
96.0000
NOP
PMS
NVR
$
0.6874
0.6874
0.8594
NOP
NXP
APX
PMS
NVR
$
0.1443
0.1443
0.1443
0.1443
0.1925
AVT
$
10.4052
AVT
$
10.4052
ABB
$
330.3900
ABB
$
417.9700
ABB
$
943.5000
44UG (12 MILLION IU) PRE-FILLED SYRINGE
02237320
REBIF (EDS)
30UG POWDER FOR IM INJECTION (VIAL)
02237770
AVONEX (EDS)
INTERFERON BETA-1B
0.3MG POWDER FOR INJECTION (3ML)
02169649
BETASERON (EDS)
KETOTIFEN FUMARATE
* 1MG TABLET
02230730
02231680
00577308
NOVO-KETOTIFEN (EDS)
PMS-KETOTIFEN (EDS)
ZADITEN (EDS)
* 0.2MG/ML SYRUP
02176084
02218305
02221330
02231679
00600784
NU-KETOTIFEN (EDS)
APO-KETOTIFEN (EDS)
PMS-KETOTIFEN (EDS)
ZADITEN (EDS)
LEFLUNOMIDE
10MG TABLET
02241888
ARAVA (EDS)
20MG TABLET
02241889
ARAVA (EDS)
LEUPROLIDE ACETATE
3.75MG/ML INJECTION
00884502
LUPRON DEPOT (EDS)
7.5MG/ML INJECTION
00836273
LUPRON DEPOT (EDS)
11.25MG (3-MONTH SR) DEPOT INJECTION
02239834
LUPRON DEPOT (EDS)
214
LEVAMISOLE
50MG TABLET
00846368
ERGAMISOL (EDS)
JAN
$
5.1538
HLR
$
0.2767
HLR
$
0.4557
HLR
$
0.7650
RTP
NXP
APX
NOP
BMY
$
0.2745
0.2745
0.2745
0.2745
0.4580
RTP
NXP
APX
NOP
BMY
$
0.4107
0.4107
0.4107
0.4107
0.6839
RTP
NXP
APX
NOP
BMY
$
0.4585
0.4585
0.4585
0.4585
0.7634
BMY
$
0.6746
BMY
$
1.2443
MSD
$
1.3758
MSD
$
1.5190
MSD
$
2.2351
LEVODOPA/BENZERAZIDE
50MG/12.5MG CAPSULE
00522597
PROLOPA
100MG/25MG CAPSULE
00386464
PROLOPA
200MG/50MG CAPSULE
00386472
PROLOPA
LEVODOPA/CARBIDOPA
* 100MG/10MG TABLET
02126176
02182831
02195933
02244494
00355658
NU-LEVOCARB
APO-LEVOCARB
NOVO-LEVOCARBIDOPA
SINEMET
* 100MG/25MG TABLET
02126168
02182823
02195941
02244495
00513997
NU-LEVOCARB
APO-LEVOCARB
NOVO-LEVOCARBIDOPA
SINEMET
* 250MG/25MG TABLET
02126184
02182858
02195968
02244496
00328219
NU-LEVOCARB
APO-LEVOCARB
NOVO-LEVOCARBIDOPA
SINEMET
100MG/25MG CONTROLLED RELEASE TABLET
02028786
SINEMET CR
200MG/50MG CONTROLLED RELEASE TABLET
00870935
SINEMET CR
MONTELUKAST SODIUM
4MG CHEWABLE TABLET
02243602
SINGULAIR (EDS)
5MG CHEWABLE TABLET
02238216
SINGULAIR (EDS)
10MG TABLET
02238217
SINGULAIR (EDS)
215
MYCOPHENOLATE MOFETIL
250MG CAPSULE
02192748
CELLCEPT (EDS)
HLR
$
2.2373
HLR
$
4.4746
ICN
$
6.7325
FEI
$
303.8000
AVT
$
27.9700
500MG TABLET
02237484
CELLCEPT (EDS)
NABILONE
1MG CAPSULE
00548375
CESAMET (EDS)
NAFARELIN ACETATE
2MG/ML NASAL SOLUTION
02188783
SYNAREL (EDS)
NEDOCROMIL SO4
2MG/DOSE INHALATION AEROSOL (PACKAGE)
02230543
TILADE
OCTREOTIDE
WHEN BILLING LAR FORM, SUBMIT QUANTITY IN TERMS OF MILLIGRAMS.
50UG INJECTION (1ML)
00839191
SANDOSTATIN (EDS)
NVR
$
5.4200
NVR
$
10.2300
NVR
$
98.3100
NVR
$
48.0400
NVR
$
113.2000
NVR
$
75.0000
NVR
$
62.3400
00839205
SANDOSTATIN (EDS)
200UG/ML INJECTION (5ML)
02049392
SANDOSTATIN (EDS)
00839213
SANDOSTATIN (EDS)
10MG/VIAL POWDER FOR INJECTION (MG)
02239323
SANDOSTATIN LAR (EDS)
02239324
02239325
216
PAMIDRONATE DISODIUM
* 30MG INJECTION
02244550
02059762
PAMIDRONATE DISODIUM(EDS)
AREDIA (EDS)
DBU
NVR
$
108.4800
170.8900
DBU
$
216.9500
DBU
NVR
$
325.4300
502.5000
JAN
$
1.2912
DPY
$
0.2696
PERMAX
DPY
$
0.9883
PERMAX
DPY
$
3.3690
BOE
$
1.0742
MIRAPEX
BOE
$
2.1483
MIRAPEX
BOE
$
2.1483
BOE
$
2.1483
PHU
$
4.0500
PGA
$
1.8011
PGA
$
11.6638
60MG INJECTION
02244551
* 90MG INJECTION
02244552
02059789
AREDIA (EDS)
PENTOSAN POLYSULFATE SO4
100MG CAPSULE
02029448
ELMIRON (EDS)
PERGOLIDE MESYLATE
0.05MG TABLET
02123320
PERMAX
0.25MG TABLET
02123339
1MG TABLET
02123347
PRAMIPEXOLE DIHYDROCHLORIDE
0.25MG TABLET
02237145
MIRAPEX
0.5MG TABLET
02241594
1MG TABLET
02237146
1.5MG TABLET
02237147
MIRAPEX
RIFABUTIN
150MG CAPSULE
02063786
MYCOBUTIN (EDS)
RISEDRONATE SODIUM
5MG TABLET
02242518
ACTONEL (EDS)
30MG TABLET
02239146
ACTONEL (EDS)
217
RIVASTIGMINE
1.5MG CAPSULE
02242115
EXELON (EDS)
NVR
$
2.4901
NVR
$
2.4901
NVR
$
2.4901
NVR
$
2.4901
REQUIP
GSK
$
0.2794
REQUIP
GSK
$
1.1176
REQUIP
GSK
$
1.2293
REQUIP
GSK
$
3.4644
NXP
NOP
APX
GPM
MED
PMS
DOM
DPY
$
1.0996 *
1.3726
1.3726
1.3726
1.3726
1.3726
1.5445
2.1793
GZY
$
0.7704
GZY
$
1.5407
WYA
$
7.3889
3MG CAPSULE
02242116
EXELON (EDS)
4.5MG CAPSULE
02242117
EXELON (EDS)
6MG CAPSULE
02242118
EXELON (EDS)
ROPINIROLE HCL
0.25MG TABLET
02232565
1MG TABLET
02232567
2MG TABLET
02232568
5MG TABLET
02232569
SELEGILINE HCL
* 5MG TABLET
02230717
02068087
02230641
02231036
02237289
02238102
02238340
02123312
NU-SELEGILINE (EDS)
NOVO-SELEGILINE (EDS)
APO-SELEGILINE (EDS)
GEN-SELEGILINE (EDS)
MED-SELEGILINE (EDS)
PMS-SELEGILINE (EDS)
DOM-SELEGILINE (EDS)
ELDEPRYL (EDS)
SEVELAMER HCL
400MG TABLET
02244309
RENAGEL (EDS)
800MG TABLET
02244310
RENAGEL (EDS)
SIROLIMUS
02243237
RAPAMUNE (EDS)
218
SODIUM CROMOGLYCATE
20MG/CAPSULE AEROSOL POWDER
00261238
INTAL SPINCAPS
AVT
$
0.5007
AVT
$
1.1621
PMS
APX
NXP
DOM
$
0.5258
0.5258
0.5258
0.6562
AVT
$
42.8600
AVT
$
0.3521
FUJ
$
2.1375
FUJ
$
2.6583
FUJ
$
12.5500
FUJ
$
127.5000
BOE
$
1.0308
RBP
$
2.1700
PANECTYL
AVT
$
0.2256
PANECTYL
AVT
$
0.2805
100MG CAPSULE
00500895
NALCROM (EDS)
* 10MG/ML INHALATION SOLUTION (2ML)
02046113
02231431
02231671
02145448
PMS-SODIUM CROMOGLYCATE
APO-CROMOLYN
NU-CROMOLYN
DOM-SODIUM CROMOGLYCATE
1MG/DOSE PRESSURIZED AEROSOL (PACKAGE)
00555649
INTAL
SODIUM FLUORIDE
20MG TABLET
02099225
FLUOTIC
TACROLIMUS
0.5MG CAPSULE
02243144
PROGRAF (EDS)
1MG CAPSULE
02175991
PROGRAF (EDS)
5MG CAPSULE
02175983
PROGRAF (EDS)
5MG/ML AMPOULE
02176009
PROGRAF (EDS)
TAMSULOSIN HCL
0.4MG SUSTAINED RELEASE CAPSULE
02238123
FLOMAX
TETRABENAZINE
25MG TABLET
02199270
NITOMAN
TRIMEPRAZINE TARTRATE
2.5MG TABLET
01926306
5MG TABLET
01926292
219
URSODIOL
250MG TABLET
02238984
URSO (EDS)
AXC
$
1.3385
AST
$
0.7595
ZAFIRLUKAST
20MG TABLET
02236606
ACCOLATE (EDS)
220
APPENDICES
APPENDIX A - EXCEPTION DRUG STATUS PROGRAM
APPENDIX B - HOSPITAL BENEFIT DRUG LIST
APPENDIX C - TIPS ON PRESCRIPTION WRITING AND
PRESCRIPTION REGULATIONS
APPENDIX D - GUIDELINES FOR REPORTING ADVERSE
DRUG REACTIONS
APPENDIX E - SPECIAL COVERAGES
APPENDIX F - TRIPLICATE PRESCRIPTION PROGRAM
APPENDIX G - CODES FOR PHARMACY ON-LINE CLAIMS
PROCESSING
APPENDIX H - MAINTENANCE DRUG SCHEDULE
APPENDIX I - TRIAL PRESCRIPTION PROGRAM
MEDICATION LIST
APPENDIX J - SASKATCHEWAN MS DRUGS PROGRAM
APPENDIX A
EXCEPTION DRUG STATUS PROGRAM
NOTES REGARDING THE EXCEPTION DRUG STATUS (EDS) PROGRAM
• Physicians, dentists, duly qualified optometrists (or authorized office staff) and
•
•
•
•
•
•
•
•
pharmacists may apply for EDS.
Requests can be submitted by telephone, by mail or by fax. A toll-free line with an
electronic message system is available exclusively for requests on a 24-hour basis.
The telephone number to access this line is 1-800-667-2549, the Drug Plan EDS Unit
fax number is (306) 798-1089.
Requests are processed daily on a continuous basis. Please allow Drug Plan staff
24 hours to process requests.
Patients are notified by letter if coverage has been approved and the time period for
which coverage has been approved.
If a request has been denied, letters are sent to the patient and prescriber notifying
them of the reason for the denial. In most cases, the Drug Plan requires more
information to determine the patient's eligibility for coverage, and will reconsider
coverage at such time as further information is received.
If the drug requested is not a benefit under the Drug Plan, the patient and prescriber
are notified. Payment for the medication is the responsibility of the patient in these
cases. It is important to note that not all medications currently available on the
market in Canada are benefits under the Saskatchewan Drug Plan or under the
Exception Drug Status Program of the Drug Plan.
The majority of EDS requests are routinely backdated 30 days from the time the Drug
Plan receives the request. Provision can be made for further backdating of EDS
coverage on a case-by-case basis. However, the Drug Plan cannot backdate further
than one year from the current date.
Saskatchewan Prescription Drug Plan policy does not allow a fee to be charged to
clients for Exception Drug Status applications made to the Drug Plan on the client's
behalf.
See NOTES CONCERNING THE FORMULARY, pages xii-xiii for additional general
information regarding Exception Drug Status coverage
CRITERIA FOR COVERAGE UNDER EXCEPTION DRUG STATUS
Following are the criteria for coverage of certain drugs under Exception Drug Status.
Coverage may be provided for other products in certain instances. Further information
can be provided by professional staff at the Drug Plan.
Certain products may be granted Exception Drug Status for non-approved indications.
This is the case only when the Saskatchewan Formulary Committee has reviewed
evidence to demonstrate safety and efficacy and the prescriber is aware the drug is being
prescribed for a non-approved indication.
The following information is required to process all Exception Drug Status requests:
•
patient name; patient Health Services Number (9 digits); name of drug;
diagnosis* relevant to use of drug; prescriber name and phone number.
*For pharmacist-initiated EDS requests:
The diagnosis, which must be obtained from the physician or physician's agent, is to be
consistently documented within the pharmacy, whether the documentation is on the
original prescription, computer file, or EDS fax form.
222
____________________________________________
abacavir SO4, oral solution, 20mg/mL; tablet, 300mg (Ziagen-GSK)
For management of HIV disease. This drug, as with other antivirals in treatment of
HIV, should be used under the direction of an infectious disease specialist.
abacavir SO4/lamivudine/zidovudine, tablet, 300mg/150mg/300mg (Trizivir-GSK)
For management of HIV disease. This drug, as with other antivirals in the treatment
of HIV, should be used under the direction of an infectious disease specialist.
acitretin, capsule, 10mg, 25mg (Soriatane-HLR)
For treatment of severe intractable psoriasis, Darier's Disease, ichthyosiform
dermatoses, palmoplantar pustulosis and other disorders of keratinization. For
detailed patient information see page 257.
Accolate - see zafirlukast
Actonel - see risedronate sodium
Actos - see pioglitazone HCl
Acular - see ketorolac tromethamine
Advair - see salmeterol xinafoate/fluticasone propionate
Advair Diskus - see salmeterol xinafoate/fluticasone propionate
Agenerase - see amprenavir
Aggrenox - see dipyridamole/acetylsalicylic acid
alendronate sodium, tablet, 10mg (Fosamax-MSD)
(a) For treatment of osteoporosis in patients who do not respond to etidronate
disodium/calcium (Didrocal) after receiving it for one year.
(b) For treatment of osteoporosis in patients unable to tolerate etidronate
disodium/calcium (Didrocal).
(c) For treatment of osteoporosis in patients who have fresh fractures.
For treatment of symptomatic Paget’s Disease of the bone.
disodium /calcium (Didrocal) after receiving it for one year.
Alertec - see modafinil
alfacalcidol, capsule, 0.25ug, 1ug; oral drops, 2ug/mL (One-Alpha-LEO)
For management of hypocalcemia and osteodystrophy in chronic renal disease
patients prior to initiation of dialysis. Note: Coverage for dialysis patients is provided
under the Saskatchewan Aids to Independent Living (S.A.I.L.) Program. Exception
Drug Status coverage is not required for S.A.I.L. patients.
Amatine - see midodrine HCl
Amerge – see naratriptan HCl
223
amoxicillin trihydrate/potassium clavulanate, tablet, 875mg/125mg; oral
suspension, 40mg/5.3mg/mL, 80mg/11.4mg/mL (Clavulin-GSK);
* oral suspension, 25mg/6.25mg/mL, 50mg/12.5mg/mL (Clavulin-GSK) (Apo-Amoxi
Clav-APX) (ratio-Amoxi Clav-RTP)
* tablet, 250mg/125mg, 500mg/125mg (Clavulin-GSK) (Apo-Amoxi Clav-APX) (ratioAmoxi Clav-RTP)
For treatment of:
(a) Upper and lower respiratory tract infections in patients not responding to first-line
antibiotics.
(b) Infections caused by organisms known to be resistant to or not responding to
alternative antibiotics.
(c) Respiratory tract infections in nursing home patients.
(d) Pneumonia in patients in the community with comorbidity eg. chronic underlying
lung disease (excluding asthma), diabetes mellitus, renal insufficiency, heart
failure, stroke.
(e) Infection in patients with neutropenia.
(f) Pneumonia caused by aspiration.
(g) For human, cat and dog bites.
(h) Diabetic foot infections, and:
(i) For completion of treatment initiated in hospital.
amprenavir, capsule, 50mg, 150mg; oral solution, 15mg/mL (Agenerase-GSK)
For management of HIV disease in patients who have failed other protease inhibitor
combinations. This drug, as with other antivirals in treatment of HIV, should be used
under the direction of an infectious disease specialist.
Androcur - see cyproterone acetate
Apo-Amoxi Clav - see amoxicillin trihydrate/potassium clavulanate
Apo-Carbamazepine CR - see carbamazepine
Apo-Cefaclor - see cefaclor
Apo-Cefuroxime - see cefuroxime axetil
Apo-Cyclobenzaprine - see cyclobenzaprine HCl
Apo-Desmopressin - see desmopressin
Apo-Etodolac - see etodolac
Apo-Flavoxate - see flavoxate
Apo-Fluconazole - see fluconazole
Apo-Ketoconazole - see ketoconazole
Apo-Ketotifen - see ketotifen fumarate
Apo-Lactulose - see lactulose
Apo-Megestrol - see megestrol acetate tablet
Apo-Minocycline - see minocycline HCl
Apo-Nabumetone - see nabumetone
Apo-Norflox - see norfloxacin
Apo-Selegiline - see selegiline HCl
Apo-Ticlopidine - see ticlopidine HCl
Apo-Zidovudine - see zidovudine
Arava - see leflunomide
Aredia - see pamidronate
Aricept - see donepezil HCl
Aristospan - see triamcinolone/hexacetonide
224
atovaquone, suspension, 150mg/mL (Mepron-GSK)
For treatment of pneumocystis carinii pneumonia (PCP) in patients who are intolerant
to trimethoprim/sulfamethoxazole.
Avandia - see rosiglitazone maleate
Avelox - see moxifloxacin HCl
Avonex – see Appendix J
azithromycin, tablet, 250mg; oral suspension, 20mg/mL, 40mg/mL (Zithromax-PFI)
For treatment of:
(a) Pneumonia.
(b) Upper and lower respiratory tract bacterial infections known to be resistant to or
not responding to alternative antibiotics.
(c) Infections in patients allergic to alternative antibiotics.
(d) Non-tuberculous Mycobacterium infections (and prophylaxis).
(e) Chlamydia trachomatis infections, and:
(f) For completion of treatment initiated in hospital with macrolides or quinolones.
(g) For patients intolerant to erythromycin and/or other antibiotics.
azithromycin, tablet, 600mg (Zithromax-PFI)
For prophylaxis and treatment of non-tuberculous Mycobacterium infections.
baclofen, injection, 0.05mg/mL, 0.5mg/mL, 2mg/mL (Lioresal Intrathecal-NVR)
(a) For treatment of severe spastic conditions in patients who do not respond to oral
baclofen.
(b) For treatment of severe spastic conditions in patients who cannot tolerate oral
baclofen.
Betaseron - see Appendix J
bezafibrate, tablet, 200mg (pms-Bezafibrate-PMS); sustained release tablet, 400mg
(Bezalip SR-HLR)
(a) For treatment of patients with hyperlipidemia who have failed to respond to
gemfibrozil or fenofibrate.
(b) For treatment of patients with hyperlipidemia who have experienced side effects
with gemfibrozil or fenofibrate.
Bezalip SR - see bezafibrate
Biaxin - see clarithromycin
Biaxin XL - see clarithromycin
bisoprolol fumarate, tablet, 5mg, 10mg (Monocor-BVL)
For treatment of patients with stable symptomatic congestive heart failure taking
diuretics and ACE inhibitors, with or without digoxin.
bosentan, tablet, 62.5mg, 125mg (Tracleer-ACT)
For patients with pulmonary arterial hypertension on the recommendation of a
specialist.
Botox - see botulinum toxin type A
225
botulinum toxin type A, sterile lyophilized powder, 100IU (Botox-ALL)
(a) For treatment of eye dystonias, that is, blepharospasm and strabismus.
(b) For treatment of cervical dystonia, that is, torticollis.
(c) For treatment of other forms of severe spasticity.
budesonide, controlled ileal release capsule, 3mg (Entocort-AST)
(a) For treatment of patients with mild to moderate Crohn's Disease affecting the
ileum and/or ascending colon. Coverage will be provided for up to 8 weeks.
(b) Maintenance treatment will be approved for patients unresponsive or intolerant to
other agents.
bumetanide, tablet, 2mg (Burinex-LEO)
For treatment of patients unable to tolerate furosemide.
bupropion HCl, tablet, 100mg, 150mg (Wellbutrin SR-GSK)
For treatment of depression.
Burinex - see bumetanide
buserelin acetate, intranasal solution, 1.05mg/mL; injection, 1.05mg/mL (SuprefactHRU)
(a) For treatment of endometriosis, for a maximum of 6 months. Coverage may be
repeated after a six month lapse, for another 6 month course.
(b) For pre-treatment of uterine fibroids prior to surgical removal, for a maximum of 6
months.
(c) For treatment of menorrhagia in preparation for endometrial ablation, for a
maximum of 6 months.
cabergoline, tablet, 0.5mg (Dostinex-PHU)
(a) For treatment of hyperprolactinemic disorders in patients not responding to
bromocriptine.
(b) For treatment of hyperprolactinemic disorders in patients intolerant to
bromocriptine.
Calcimar - see calcitonin salmon
+calcitonin salmon, injection, 100IU/mL (Caltine-FEI), 200IU/mL (Calcimar-AVT)
(a) For symptomatic treatment of Paget's Disease of the bone.
(b) For treatment of crush fracture with bone pain. Coverage will be provided for a
(c) For treatment of osteogenesis imperfecta.
calcitonin salmon, nasal spray, 200IU/dose (Miacalcin-NVR)
(a) For treatment of osteoporosis in patients unable to tolerate listed
bisphosphonates.
(b) For treatment of osteoporosis in patients not responding to listed
bisphosphonates after treatment for one year.
(c) For treatment of crush fracture with bone pain. Coverage will be provided for a
maximum of 3 months as an alternative to the subcutaneous dosage form.
226
calcitriol, capsule, 0.25ug, 0.5ug; oral solution, 1ug/mL (Rocaltrol-HLR)
(a) For management of hypocalcemia and osteodystrophy in patients with chronic
renal failure undergoing renal dialysis. Note: Coverage for dialysis patients is
provided under the Saskatchewan Aids to Independent Living (SAIL) Program.
Exception Drug Status coverage is NOT required for SAIL patients.
(b) For management of hypocalcemia and clinical manifestations associated with
post-surgical hypoparathyroidism, idiopathic hypoparathyroidism,
pseudohypoparathyroidism, or vitamin D resistant rickets.
Caltine - see calcitonin salmon
*carbamazepine, controlled release tablet, 200mg, 400mg (Tegretol CR-NVR) (pmsCarbamazepine-CR-PMS) (Dom-Carbamazepine CR-DOM) (Taro-Carbamazepine
CR-TAR) (Gen-Carbamazepine CR-GPM) (Apo-Carbamazepine CR-APX)
For treatment in patients experiencing inadequate control or occurrence of
unacceptable adverse reactions using the regular tablet dosage form.
carvedilol, tablet, 3.125mg, 6.25mg, 12.5mg, 25mg (Coreg-GSK)
For treatment of patients with stable symptomatic congestive heart failure taking
diuretics and ACE inhibitors, with or without digoxin.
Ceclor - see cefaclor
*cefaclor, suspension, 25mg/mL, 50mg/mL, 75mg/mL (Ceclor-LIL) (Apo-CefaclorAPX) (Dom-Cefaclor-DOM) (pms-Cefaclor-PMS); capsule, 250mg, 500mg (pmsCefaclor-PMS) (Apo-Cefaclor-APX) (Dom-Cefaclor-DOM) (Nu-Cefaclor-NXP)
(Novo-Cefaclor-NOP) Note: All forms and strengths of cefaclor are scheduled to be
delisted from the Saskatchewan Formulary effective April 1, 2003.
(a) For treatment of infections in patients with underlying lung disease not
responding to first-line antibiotics.
(b) For treatment of infections in patients allergic to alternative antibiotics. (Note:
patients with immediate hypersensitivity to penicillin should not receive
cephalosporins.)
(c) For treatment of infections caused by organisms known to be resistant to
(d) For treatment of respiratory tract infections in nursing home patients.
(e) For treatment of pneumonia in patients in the community with comorbidity (ie.
COPD, diabetes mellitus, renal insufficiency, heart failure).
(f) For step-down care following hospital separation in patients treated with
intravenous antibiotics (guided by culture and sensitivity results).
cefixime, tablet, 400mg; oral suspension, 20mg/mL (Suprax-AVT)
For treatment of:
(a) Infections in patients allergic to alternative antibiotics. (Note: patients who have
had an anaphylactic reaction to penicillin should not receive cephalosporins.)
(b) Infections caused by organisms known to be resistant to or not responding to
(c) Uncomplicated gonorrhea.
227
cefprozil, tablet, 250mg, 500mg; suspension, 25mg/mL, 50mg/mL (Cefzil-BMY)
For treatment of:
antibiotics.
(b) Infections caused by organisms known to be resistant or not responding to
(c) Infections in patients allergic to alternative antibiotics. (Note: patients who have
(d) Respiratory tract infections in nursing home patients.
(e) Pneumonia in patients in the community with comorbidity eg. chronic underlying
failure, stroke, and:
(f) For completion of antibiotic treatment initiated in hospital.
Ceftin - see cefuroxime axetil
cefuroxime axetil, suspension, 25mg/mL (Ceftin-GSK)
*tablet, 250mg, 500mg (Ceftin-GSK) (ratio-Cefuroxime-RTP) (Apo-Cefuroxime-APX)
For treatment of:
antibiotics.
(b) Infections caused by organisms known to be resistant or not responding to
(c) Infections in patients allergic to alternative antibiotics. (Note: patients who have
(d) Respiratory tract infections in nursing home patients.
(e) Pneumonia in patients in the community with comorbidity ie. chronic underlying
failure, stroke, and:
(f) For completion of antibiotic treatment initiated in hospital.
Cefzil - see cefprozil
Celebrex - see celecoxib
celecoxib, capsule, 100mg, 200mg (Celebrex-PHU)
(a) For treatment in patients age 65 and over (approved automatically through the
on-line computer system).
(b) For treatment of rheumatoid arthritis and osteoarthritis in patients who have one
of the following factors:
•
past history of ulcers;
•
concurrent prednisone therapy;
•
concurrent warfarin therapy.
(c) For treatment of patients with an intolerance to other NSAIDs listed in the
Formulary.
CellCept - see mycophenolate mofetil
Cesamet - see nabilone
chorionic gonadotropin, injection, 10,000IU/vial (Profasi HP-SRO)
(a) For treatment of habitual abortion.
(b) For treatment of delayed puberty.
Ciloxan - see ciprofloxacin
Cipro - see ciprofloxacin tablet
228
Cipro HC - see ciprofloxacin/hydrocortisone
ciprofloxacin, ophthalmic solution, 0.3%; ophthalmic ointment, 0.3% (Ciloxan-ALC)
For treatment of ophthalmic infections caused by gram-negative organisms or those
not responding to alternative agents.
ciprofloxacin, tablet, 250mg, 500mg, 750mg; oral suspension, 100mg/mL (Cipro-BAY)
For treatment of:
(a) Infections caused by Pseudomonas aeruginosa.
(b) Infections in patients allergic to two or more alternative antibiotics.
(c) Infections known to be resistant to alternative antibiotics.
(d) Patients with severe diabetic foot infections in combination with other antibiotics.
(e) Infection (and prophylaxis) in patients with prolonged neutropenia.
(f) Genitourinary tract infections in patients allergic or not responding to alternative
antibiotics.
(g) Patients with bronchiectasis or cystic fibrosis.
(h) Gonorrhea, and:
(i) For completion of antibiotic treatment initiated in hospital when alternatives are
not appropriate.
ciprofloxacin/hydrocortisone, otic suspension, 0.2%/1% (Cipro HC-ALC)
(a) For treatment of otitis externa in patients who have failed previous treatment with
listed combination anti-infective/anti-inflammatory agents.
(b) For treatment of patients with perforation of the tympanic membrane.
clarithromycin, tablet, 250mg, 500mg; oral suspension, 25mg/mL, 50mg/mL (Biaxin-ABB);
extended-release tablet, 500mg (Biaxin XL-ABB)
For treatment of:
(a) Pneumonia.
(b) Upper and lower respiratory tract bacterial infections known to be resistant to or
not responding to alternative antibiotics.
(c) Infections in patients allergic to alternative antibiotics.
(d) Non-tuberculous Mycobacterium infections (and prophylaxis), and:
(e) For one week for eradication of H. pylori-related infections when used in
combination treatment regimens for the treatment of peptic ulcer disease.
(f) For completion of treatment initiated in hospital with macrolides or quinolones.
(g) For patients intolerant to erythromycin and/or other antibiotics.
Clavulin - see amoxicillin trihydrate/potassium clavulanate
Climara - see estradiol
clonidine HCl, tablet, 0.025mg (Dixarit-BOE)
(a) For treatment of menopausal flushing in patients unable to tolerate estrogen
therapy.
(b) For treatment of Attention Deficit Disorder.
clopidogrel bisulfate, tablet, 75mg (Plavix-SAW)
(a) For treatment of patients who have experienced a recurrent vascular episode
while on acetylsalicylic acid.
(b) For treatment of patients who have experienced a recurrent vascular episode
and have a clearly demonstrated allergy to acetylsalicylic acid (manifested by
asthma or nasal polyps).
(c) For treatment of patients who have experienced a recurrent vascular episode
and are intolerant of acetylsalicylic acid (manifested by gastrointestinal
hemorrhage).
(d) When prescribed following intracoronary stent placement. Coverage will be
provided for a period of 4 weeks.
Clopixol - see zuclopenthixol
229
clozapine, tablet, 25mg, 100mg (Clozaril-NVR)
For treatment of patients with schizophrenia who are either treatment resistant or
treatment intolerant and have no other medical contraindications.
Clozaril - see clozapine
codeine, controlled release tablet, 50mg, 100mg, 150mg, 200mg (Codeine ContinPFR)
(a) For treatment of palliative and chronic pain patients as an alternative to
ASA/codeine combination products or acetaminophen/codeine combination
products.
(b) For treatment of palliative and chronic pain patients as an alternative to the
regular release tablet when large doses are required.
In non-palliative patients, coverage will only be approved for a 6 month course of
therapy, subject to review.
Codeine Contin - see codeine
Combivir – see lamivudine/zidovudine
Copaxone - see Appendix J
Coreg - see carvedilol
Crixivan - see indinavir SO4
*cyclobenzaprine HCl, tablet, 10mg (Flexeril-JAN) (Apo-Cyclobenzaprine-APX)
(Novo-Cycloprine-NOP) (Nu-Cyclobenzaprine-NXP) (pms-Cyclobenzaprine-PMS)
(Gen-Cyclobenzaprine-GPM) (Med-Cyclobenzaprine-MED) (Flexitec-TCH) (DomCyclobenzaprine-DOM)
As an adjunct to rest and physical therapy for relief of muscle spasm associated with
acute, painful musculoskeletal conditions not responding or experiencing severe
adverse reactions to alternative therapy. Coverage will be provided for up to a 3 week
period.
cyclosporine, capsule, 10mg, 25mg, 50mg, 100mg; liquid, 100mg/mL (Neoral-NVR)
(a) For induction and maintenance of remission of severe psoriasis in patients for
whom conventional therapy is ineffective or inappropriate.
(b) For treatment of patients with severe active rheumatoid arthritis for whom
classical slow-acting anti-rheumatic agents are inappropriate or ineffective.
(c) For treatment of nephrotic syndrome.
For the above indications prescriptions are subject to deductible and co-payment as
for other drugs covered under the Drug Plan. Pharmacies note: claims on behalf
of these patients must use the following identifying numbers (not the DIN):
10mg – 00950792
100mg – 00950815
25mg – 00950793
100mg/mL - 00950823
50mg – 00950807
cyclosporine, capsule, 10mg, 25mg, 50mg, 100mg; liquid, 100mg/mL (Neoral-NVR)
For prophylaxis of graft rejection following solid organ transplant and bone marrow
transplant procedures. In such cases, the cost is covered at 100% and the deductible
does not apply.
cyproterone acetate, injection, 100mg/mL (Androcur Depot-PMS);
*tablet, 50mg (Androcur-PMS) (Gen-Cyproterone-GPM) (Novo-Cyproterone-NOP)
For treatment of hirsuitism.
230
Cytovene - see ganciclovir sodium
dalteparin sodium, syringe, 2,500IU (0.2mL), 5,000IU (0.2mL); injection solution,
10,000IU/mL (1mL), 25,000IU/mL (3.8mL) (Fragmin-PHU)
(a) For treatment of venous thromboembolism for up to 10 days.
(b) For prophylaxis following total knee arthroplasty and major orthopedic trauma for
up to 10 days (treatment duration may be reassessed).
(c) For longterm outpatient prophylaxis in patients who are pregnant.
(d) For longterm outpatient prophylaxis in patients who are intolerant to, or have
failed, warfarin therapy.
(e) For longterm outpatient prophylaxis in patients who have lupus anticoagulant
syndrome.
DDAVP - see desmopressin acetate
delavirdine mesylate, tablet, 100mg (Rescriptor-PHU)
*deferoxamine mesylate, powder for solution, 500mg/vial, 2g/vial
(pms-Deferoxamine-PMS) (Desferal-NVR)
For treatment of iron overload in patients with transfusion-dependent anemias.
Desferal - see deferoxamine mesylate
desmopressin, tablet, 0.1mg, 0.2mg (DDAVP-FEI)
*intranasal solution, 10ug/dose (DDAVP-FEI) (Apo-Desmopressin-APX)
(a) For treatment of diabetes insipidus.
(b) For treatment of enuresis in children over 5 years of age refractory to bed-wetting
alarms or alternative agents listed in the Formulary.
desmopressin, injection, 4ug/mL (DDAVP-FEI); intranasal solution, 150ug/dose
(Octostim-FEI)
For prophylaxis of mild hemophilia A and mild von Willebrand's Disease.
Detrol - see tolterodine l-tartrate
diclofenac sodium, ophthalmic solution, 0.1% (Voltaren Ophtha-NVO)
(a) For treatment of post-operative ocular inflammation in patients undergoing
cataract surgery.
(b) For prophylaxis of aphakic macular edema following cataract surgery.
(c) For treatment of long-term inflammatory conditions not responding to short-term
topical steroids.
didanosine, powder for oral solution (package), 4g; chewable tablet, 25mg, 50mg,
100mg, 150mg (Videx-BMY); capsule (enteric coated beadlet), 125mg, 200mg,
250mg, 400mg (Videx EC-BMY)
Didronel - see etidronate disodium
Diflucan - see fluconazole
231
dipyridamole, tablet, 25mg, 50mg, 75mg (Persantine-BOE)
(a) Following transluminal angioplasty, for a maximum of 6 months.
(b) Following bypass surgery, for a maximum of 12 months.
(c) Following prosthetic heart valve replacement, for 12 months. This is renewable
on a yearly basis.
dipyridamole/acetylsalicylic acid, capsule, 200mg/25mg (Aggrenox-BOE)
For treatment of patients who have had a stroke or transient ischemic attack while on
acetylsalicylic acid.
Dixarit - see clonidine HCl
Dom-Carbamazepine CR – see carbamazepine
Dom-Cefaclor - see cefaclor
Dom-Cyclobenzaprine – see cyclobenzaprine HCl
Dom-Minocycline - see minocycline HCl
Dom-Selegiline – see selegiline HCl
Dom-Ticlopidine - see ticlopidine HCl
donepezil HCl, tablet, 5mg, 10mg (Aricept-PFI)
(a) A diagnosis of probable Alzheimer's Disease as per DSM-IV criteria.
(b) A mild to moderate stage of the disease with a MMSE score of 10-26 established
within 60 days prior to application for coverage by a clinician.
(c) A Functional Activities Questionnaire (FAQ) must be completed.
(d) Patients must discontinue all drugs with anticholinergic activity at least 14 days
before the MMSE and FAQ are administered. Drugs with anticholinergic activity
are not to be used concurrently with donepezil therapy. List all current
medications patient was taking at the time of assessment.
(e) Patients intolerant to one drug may be switched to another drug in this class.
Intolerance should be observed within the first month of treatment.
•
Eligible patients currently taking donepezil would require assessment at 6
month intervals. To continue receiving donepezil, patients must not have both a
greater than 2 point reduction in MMSE and a 1 point increase in FAQ in a 6
month evaluation period. Scores are compared to the most recent test results.
•
Eligible new patients will enter a 3 month treatment period with donepezil.
During the 3 month trial, patients must exhibit an improvement from the initial
MMSE or FAQ to continue treatment with donepezil. The improvement must be
at least 2 MMSE points or -1 FAQ. Patients who meet these requirements will be
re-evaluated at 6 month intervals. To continue receiving donepezil, patients must
not have both a greater than 2 point reduction in MMSE and a 1 point increase in
FAQ in a 6 month evaluation period. Scores are compared to the most recent
test results.
•
The MMSE score must remain at 10 or greater at all times to be eligible for
coverage.
•
Patients who do not meet criteria to continue donepezil can be re-evaluated
within 3 months to confirm deterioration before coverage is discontinued.
•
Donepezil does not need to be discontinued prior to MMSE or FAQ testing.
•
A patient intolerant of one drug and switching to a second will be considered a
"new" patient and will be assessed as such.
•
Coverage will not be considered for patients who have failed on other drugs in
this class.
Applications for EDS for donepezil (Aricept) will only be accepted from physicians on
the Aricept/Exelon/Reminyl EDS application form. This form is available on-line at
http://formulary.drugplan.health.gov.sk.ca or by calling the Drug Plan.
232
dornase alfa, inhalation solution, 1mg/mL (Pulmozyme-HLR)
For treatment of cystic fibrosis patients who meet the following criteria:
(a) at least 5 years of age
(b) Lung function greater than 40% (as measured by FVC)
(c) Physicians will be requested to provide evidence of the beneficial effect of this
drug in their patients after 6 months of therapy before additional coverage is
granted.
Renewal of coverage will be provided for a 6 month period if any of the following
criteria are met:
(a) FEV1 has improved by 10% from pre-treatment value
(b) decreased antibiotic utilization
(c) decreased hospitalizations
(d) decreased absenteeism from school or work
(e) if the individual deteriorates upon discontinuation of Pulmozyme therapy.
Physicians must provide appropriate documentation to establish benefit.
Dostinex - see cabergoline
doxercalciferol, capsule, 2.5ug (Hectorol-DPY)
For the management of hypocalcemia, osteodystrophy and secondary
hyperparathyroidism in chronic renal disease patients prior to initiation of dialysis.
Note: Coverage for dialysis patients is provided under the Saskatchewan Aids to
Independent Living (SAIL) Program. Exception Drug Status coverage is NOT
required for SAIL patients.
Duragesic - see fentanyl
Edecrin - see ethacrynic acid
efavirenz, capsule, 50mg, 100mg, 200mg (Sustiva-BMY)
Eldepryl - see selegiline HCl
Elmiron - see pentosan polysulfate sodium
Enbrel - see etanercept
enoxaparin, syringe, 100mg/mL (0.3mL, 0.4mL, 0.6mL, 0.8mL, 1mL); injection
solution, 100mg/mL (3mL) (Lovenox-AVT)
syndrome.
(f) For treatment of pediatric patients where anticoagulant therapy is required and
warfarin cannot be administered.
Entocort - see budesonide
233
epoetin alfa, pre-filled syringe, 1,000 IU/0.5mL, 2,000IU/0.5mL, 3,000IU/0.3mL,
4,000IU/0.4mL, 6,000IU/0.6mL, 8,000IU/0.8mL, 10,000IU/mL; sterile solution for
injection, 20,000IU (Eprex-JAN)
(a) For treatment of anemia in chronic renal disease patients prior to initiation of
dialysis. Note: Coverage for dialysis patients is provided under the
Saskatchewan Aids to Independent Living (S.A.I.L.) Program. Exception Drug
Status coverage is not required for S.A.I.L. patients.
(b) For treatment of anemia in AIDS patients.
(c) For treatment of anemia in transplant patients.
Eprex - see epoetin alfa
Ergamisol - see levamisole
Estalis - see estradiol/norethindrone acetate
Estalis-Sequi - see estradiol & norethindrone acetate/estradiol
Estracomb - see estradiol & norethindrone acetate/estradiol
Estraderm - see estradiol
estradiol, transdermal gel (metered dose pump), 0.06% (Estrogel-SCH);
+transdermal therapeutic system, 25ug, 50ug, 100ug (Estraderm-NVR), 37.5ug,
50ug, 75ug, 100ug (Vivelle-NVR), 50ug, 100ug (Climara-BEX), 25ug, 50ug (OesclimPAL), 37.5ug, 50ug, 75ug, 100ug (Estradot-NVR)
For treatment in patients who are unable to tolerate oral estrogen.
estradiol/norethindrone acetate, transdermal therapeutic system (8), 50ug/140ug,
50ug/250ug (Estalis-NVR)
For treatment in patients who are unable to tolerate oral hormone replacement
therapy (either estrogen or progesterone).
estradiol & norethindrone acetate/estradiol, transdermal therapeutic system (8),
50ug & 140ug/50ug (Estalis-Sequi-NVR)
+50ug & 250ug/50ug (Estracomb-NVR) (Estalis-Sequi-NVR)
For treatment in patients who are unable to tolerate oral hormone replacement
therapy (either estrogen or progesterone).
Estradot – see estradiol
Estrogel – see estradiol
etanercept, powder for injection (vial), 25mg/vial (Enbrel-WYA)
For treatment of patients with active rheumatoid arthritis who have failed or are
intolerant to methotrexate, leflunomide and at least one other DMARD.
This product should be used in consultation with a specialist in this area.
ethacrynic acid, tablet, 50mg (Edecrin-MSD)
For treatment of patients refractory to furosemide.
etidronate disodium, tablet, 200mg (Didronel-PGA)
(a) For treatment of symptomatic Paget's Disease of the bone for a 6 month period.
Coverage can be renewed after a drug holiday of at least 90 days.
(b) For treatment of heterotopic calcification.
(c) For symptomatic management of bone pain due to cancer in the palliative care
patient.
(d) For treatment of osteoporosis in patients who are intolerant to the calcium in
Didrocal.
234
etodolac, capsule, 200mg (Apo-Etodolac-APX);
*capsule, 300mg (Ultradol-PGA) (Apo-Etodolac-APX)
For treatment of patients with an intolerance to other NSAIDS listed in the Formulary.
Evista - see raloxifene HCl
Exelon - see rivastigmine
fentanyl, transdermal system, 25ug/hr., 50ug/hr., 75ug/hr., 100ug/hr. (DuragesicJAN)
For treatment of patients who cannot tolerate, or are unable to take, oral sustainedreleased strong opioids, or as an alternative to subcutaneous narcotic infusion
therapy. In non-palliative patients, coverage will only be approved for a 6-month
course of therapy.
filgrastim, injection solution, 300ug/mL (Neupogen-AMG)
(a) For treatment of patients with congenital, cyclic or idiopathic neutropenia with
absolute neutrophil counts of less than or equal to 500.
(b) For treatment of non-cancer patients who have undergone bone marrow
transplantation.
(c) For treatment of AIDS patients with absolute neutrophil counts of less than 500.
*flavoxate HCl, tablet, 200mg (Urispas-PMS) (Apo-Flavoxate-APX)
For treatment of spasms in the urinary tract in patients unresponsive or intolerant to
listed alternatives.
Flexeril - see cyclobenzaprine HCl
Flexitec - see cyclobenzaprine HCl
fluconazole, powder for oral suspension, 10mg/mL (Diflucan-PFI);
*tablet, 50mg, 100mg (Diflucan-PFI) (Apo-Fluconazole-APX) (Gen-FluconazoleGPM) (pms-Fluconazole-PMS)
(a) For treatment of fungal meningitis in immunocompromised patients.
(b) For treatment of severe or life-threatening fungal infections.
(c) For treatment of severe dermatophytoses not responding to other forms of
therapy including ketoconazole.
Note: the 150mg capsule form of fluconazole is listed in the Saskatchewan
Formulary.
flunarizine HCl, capsule, 5mg (Sibelium-JAN)
For prophylaxis of migraines in cases where alternative prophylactic agents have not
been effective.
flurbiprofen sodium, ophthalmic solution, 0.03% (Ocufen-ALL)
cataract surgery.
topical steroids.
Foradil - see formoterol fumarate
235
+formoterol fumarate, powder for inhalation (capsule), 12ug (Foradil-NVR); powder
for inhalation (package), 6ug/dose, 12ug/dose (Oxeze Turbuhaler-AST)
(a) For treatment of asthma uncontrolled on concurrent inhaled steroid therapy. It is
important that these patients also have access to a short-acting beta-2 agonist for
symptomatic relief.
(b) For treatment of Chronic Obstructive Pulmonary Disease (COPD).
formoterol fumarate dihydrate/budesonide, powder for inhalation (package),
6ug/100ug, 6ug/200ug (Symbicort Turbuhaler-AST)
(a) For treatment of asthma in patients not adequately controlled on inhaled steroid
therapy. It is important that these patients also have access to a short-acting
beta-2 agonist for symptomatic relief.
(b) For treatment of chronic obstructive pulmonary disease (COPD) in patients who
are not adequately controlled on a long-acting beta-2 agonist alone.
Fortovase – see saquinavir
Fosamax - see alendronate sodium
fosfomycin tromethamine, oral powder (sachet), 3g (Monurol-PFR)
For treatment of:
(a) Urinary tract infections with organisms resistant to first line therapy.
(b) Urinary tract infections in patients allergic to first line agents.
(c) Urinary tract infections in pregnancy when first line agents are inappropriate.
Fragmin – see dalteparin sodium
Fraxiparine – see nadroparin calcium
Fraxiparine Forte – see nadroparin calcium
Fucithalmic - see fusidic acid
fusidic acid, ophthalmic drops (preservative free), 1%; ophthalmic drops 1%
(Fucithalmic-LEO)
For patients not responding to listed alternatives.
galantamine hydrobromide, tablet, 4mg, 8mg, 12mg (Reminyl-JAN)
are not to be used concurrently with galantamine hydrobromide therapy. List all
current medications patient was taking at the time of assessment.
•
Eligible patients currently taking galantamine hydrobromide would require
assessment at 6 month intervals. To continue receiving galantamine
hydrobromide, patients must not have both a greater than 2 point reduction in
MMSE and a 1 point increase in FAQ in a 6 month evaluation period. Scores are
compared to the most recent test results.
236
•
Eligible new patients will enter a 3 month treatment period with galantamine
hydrobromide. During the 3 month trial, patients must exhibit an improvement
from the initial MMSE or FAQ to continue treatment with galantamine
hydrobromide. The improvement must be at least 2 MMSE points or -1 FAQ.
Patients who meet these requirements will be re-evaluated at 6 month intervals.
To continue receiving galantamine hydrobromide, patients must not have both a
greater than 2 point reduction in MMSE and a 1 point increase in FAQ in a 6
•
coverage.
•
Patients who do not meet criteria to continue galantamine hydrobromide can be
re-evaluated within 3 months to confirm deterioration before coverage is
discontinued.
•
Galantamine hydrobromide does not need to be discontinued prior to MMSE or
FAQ testing.
•
•
this class.
Applications for EDS for galantamine (Reminyl) will only be accepted from
physicians on the Aricept/Exelon/Reminyl EDS application form. This form is
available on-line at http://formulary.drugplan.health.gov.sk.ca or by calling the
Drug Plan.
ganciclovir sodium, capsule, 250mg, 500mg (Cytovene-HLR)
(a) For treatment of CMV retinitis and other CMV infections in immunocompromised
patients.
(b) For prevention of CMV in solid organ transplant recipients who are considered at
risk of developing CMV disease. Coverage will be granted for a period of 3
months.
gatifloxacin, tablet, 400mg (Tequin-BMY)
For treatment of:
(a) Pneumonia in patients with underlying lung disease (excluding asthma) and
pneumonia in nursing home patients.
(b) Infections caused by organisms known to be resistant to alternative antibiotics.
(c) Infections in patients allergic to two or more alternative antibiotics, and:
(d) For completion of antibiotic treatment initiated in hospital when alternatives are
not appropriate.
Gen-Carbamazepine CR - see carbamazepine
Gen-Cycloprine - see cyclobenzaprine HCl
Gen-Cyproterone - see cyproterone acetate
Gen-Fluconazole - see fluconazole
Gen-Minocycline - see minocycline HCl
Gen-Nabumetone - see nabumetone
Gen-Selegiline - see selegiline HCl
Gen-Ticlopidine - see ticlopidine HCl
glatiramer acetate, injection, 20mg (vial); 20mg (pre-filled syringe) (Copaxone-TVM)
See Appendix J
237
GlucoNorm - see repaglinide
goserelin acetate, 3.6mg/syringe (Zoladex-AST)
months.
halobetasol propionate, cream, 0.05%; ointment, 0.05% (Ultravate-WSD)
For treatment of patients refractory to or intolerant of other listed products.
Hectorol - see doxercalciferol
Heptovir – see lamivudine
Hivid - see zalcitabine
Hp-PAC – see lansoprazole/clarithromycin/amoxicillin
Humalog - see insulin lispro
Humalog Mix25 - see insulin (regular/protamine) lispro
Humatrope - see somatropin
Imitrex - see sumatriptan
indinavir SO4, capsule, 200mg, 400mg (Crixivan-MSD)
infliximab, injection (mg),100mg/vial (Remicade-SCH)
Crohn's Disease:
(a) Moderate to severe Crohn's Disease:
•
For treatment of patients who demonstrate continuing symptoms despite the
use of optimal conventional therapies such as 5-ASA agents, glucocorticoids
and immunosuppressive therapy.
•
For treatment of patients who are unable to tolerate conventional therapy
including 5-ASA agents, glucocorticoids and immunosuppressive therapy.
(b) Fistulizing Crohn's Disease:
•
For treatment of patients with symptomatic enterocutaneous or perineal
fistulae, enterovaginal fistulae or enterovesical fistulae (i.e. any type of
fistulizing Crohn’s Disease).
Note: This product should be used in consultation with a specialist in this area.
Pharmacies note: claims on behalf of Crohn's Disease patients must use the
following identifying number (not the DIN):
00950899
Rheumatoid Arthritis:
intolerant to methotrexate, leflunomide and at least one other DMARD.
Treatment should be combined with an immunosuppressant. This product should
be used in consultation with a specialist in this area.
Infufer - see iron dextran
Innohep - see tinzaparin sodium
238
insulin aspart, injection solution, 100U/ml (5x3ml) (10ml) (NovoRapid-NOO)
For treatment of difficult to control diabetes.
insulin lispro, injection solution, 100U/mL (5 x 1.5mL, 5 x 3mL) (10mL) (HumalogLIL)
(a) For treatment of patients using insulin pumps.
(b) For treatment of patients with difficult to control diabetes.
insulin (regular/protamine) lispro, injection suspension, 100U/mL, 25%/75%
(5x3mL) (Humalog Mix25-LIL)
For treatment of patients with difficult to control diabetes.
interferon alfa-2a, injection solution albumin (human) free, 3 million IU/1mL,
9 million IU/1mL, 18 million IU/3mL (Roferon-A-HLR)
(a) For treatment of chronic active hepatitis B for a period of up to 6 months.
(b) For treatment of chronic active hepatitis C. Coverage will be provided for an initial
6 month period with potential renewal for 2 additional 6 month periods.
Note: Interferons are not interchangeable. Pharmacists should dispense the product
specified by the physician.
interferon alfa-2b, powder for injection, 10 million IU; injection solution albumin
(human) free, 6 million IU/mL (0.5mL), 10 million IU/mL (0.5mL, 1mL); multi-dose
pen (kit) albumin (human) free, 18 million IU/pen, 30 million IU/pen, 60 million
IU/pen (Intron-A-SCH)
(a) For treatment of chronic active hepatitis B for a period of up to 6 months.
(b) For treatment of chronic active hepatitis C. Coverage will be provided for an initial
6 month period with potential renewal for 2 additional 6 month periods.
Note: Interferons are not interchangeable. Pharmacists should dispense the product
specified by the physician.
interferon alfa-2b/Ribavirin, injection solution albumin (human) free/capsule
(package), 6 million IU/mL(0.5mL)/200mg; multi-dose pen albumin (human)
free/capsule (package), 15 million IU/mL/200mg (Rebetron-SCH)
For treatment of hepatitis C. Coverage will be provided for an initial 6 month period
with potential renewal for 2 additional 6 month periods.
Intron A - see interferon alfa-2b
interferon beta-1a, powder for im injection, 30ug (Avonex-BGN)
See Appendix J
interferon beta-1a, pre-filled syringe, 22ug (6 million IU), 44ug (12 million IU) (RebifSRO)
See Appendix J
interferon beta-1b, powder for injection, 0.3ng (3mL) (Betaseron-BEX)
See Appendix J
Intron A - see interferon alfa-2b
Invirase - see saquinavir
239
iron dextran, injection, 50mg/mL (Infufer-SAB)
For treatment of iron deficiency when patients are intolerant to oral iron replacement
products. Note: Coverage for dialysis patients is provided under the Saskatchewan
Aids to Independent Living (S.A.I.L.) Program. Exception Drug Status coverage is not
required for S.A.I.L. patients.
itraconazole, capsule, 100mg; oral solution, 10mg/mL (Sporanox-JAN)
(a) For treatment of severe or life-threatening fungal infections.
(b) For treatment of severe dermatophytoses not responding to other forms of
therapy.
(c) For treatment of onychomycosis.
Kaletra - see lopinavir/ritonavir
*ketoconazole, tablet, 200mg (Nizoral-MCL) (Apo-Ketoconazole-APX) (Nu-KetoconNXP) (Novo-Ketoconazole-NOP)
(a) For treatment of severe or life-threatening fungal infections.
(b) For treatment of severe dermatophytoses.
(c) For treatment of dermatophytoses not responding to other forms of therapy.
ketorolac tromethamine, ophthalmic solution, 0.5% (Acular-ALL)
cataract surgery.
topical steroids.
*ketotifen fumarate, tablet, 1mg (Zaditen-NVR) (Novo-Ketotifen-NOP) (pmsKetotifen-PMS); syrup, 0.2mg/mL (Zaditen-NVR) (Novo-Ketotifen-NOP) (NuKetotifen-NXP) (Apo-Ketotifen-APX) (pms-Ketotifen-PMS)
For treatment of pediatric patients with asthma who are unresponsive to or unable to
administer alternative prophylactic agents listed in the Formulary.
lactulose, syrup, 667mg/mL (pms-Lactulose-PMS);
*solution, 667mg/mL (ratio-Lactulose-RTP) (Apo-Lactulose-APX)
For treatment of portal systemic encephalopathy.
lamivudine, tablet, 100mg (Heptovir-GSK)
For management of hepatitis B.
lamivudine, tablet, 150mg; oral solution, 10mg/mL (3TC-GSK)
lamivudine/zidovudine, tablet, 150mg/300mg (Combivir-GSK)
240
lansoprazole, delayed release capsule, 15mg, 30mg (Prevacid-ABB)
(a) For a maximum of 8 weeks in treatment of peptic ulcer disease, which includes
gastric and duodenal ulcers, in patients not responding or experiencing unusual
or severe adverse reactions to a reasonable trial with H2 blockers, sucralfate or
misoprostol. Coverage for a repeat treatment will be approved only after a 3-6
month period of no treatment or prophylaxis with an H2 blocker, sucralfate or
misoprostol.
(b) For one year in treatment of symptoms of gastroesophageal reflux disease
(GERD). It was noted that patients with non-erosive GERD could potentially be
reduced to step-down therapy with an H2 antagonist depending on symptom
resolution.
(c) For one year in treatment of severe erosive esophagitis and Zollinger-Ellison
Syndrome. This is renewable on a yearly basis.
(d) For one week for eradication of H. pylori-related infections in individuals with
peptic ulcer disease. Provision will be made for additional coverage in treatment
failures.
(e) For first-line prevention of gastroduodenal hemorrhage in high risk patients with
prior history of gastroduodenal bleeds for whom anticoagulant,
glucocorticosteroid or NSAID therapy cannot be avoided. Coverage is renewable
on a yearly basis for patients if discontinuation of offending agents or
replacement with less damaging alternatives is not feasible.
lansoprazole/clarithromycin/amoxicillin, 7 day package, 30mg/500mg/500mg (HpPAC-ABB)
For one week for eradication of H. pylori-related infections in individuals with peptic
ulcer disease. Provision will be made for additional coverage in treatment failures.
leflunomide, tablet, 10mg, 20mg (Arava-AVT)
intolerant to methotrexate and at least one other DMARD (e.g. sulfasalazine,
azathioprine or hydroxychloroquine).
Note: Leflunomide is contraindicated in patients with pre-existing impairment of liver
function.
Leucovorin - see leucovorin calcium
leucovorin calcium, tablet, 5mg (Leucovorin-WYA)
For treatment of folic acid deficiency in patients who have been on long-term therapy
with trimethoprim/sulfamethoxazole.
leuprolide acetate, injection, 3.75mg/mL, 7.5mg/mL; depot injection, 11.25mg (3month SR) (Lupron Depot-ABB)
months.
levamisole, tablet, 50mg (Ergamisol-JAN)
For treatment of high-dose steroid-dependent nephrotic syndrome in children as
adjunct therapy following relapse on corticosteroids.
Levaquin – see levofloxacin
241
levofloxacin, tablet, 250mg, 500mg (Levaquin-JAN)
For treatment of:
not appropriate.
Lin-Megestrol - see megestrol acetate tablet
linezolid, tablet, 600mg (Zyvoxam-PHU)
Following consultation with an infectious disease specialist for:
(a) Treatment of gram-positive infections resistant to vancomycin.
(b) Treatment of gram-positive infections in patients unable to tolerate or who are
experiencing severe adverse effects from vancomycin.
(c) For completion of therapy initiated in hospital with intravenous vancomycin,
quinupristin/dalfopristin or linezolid for patients who can be discharged on oral
therapy.
Lioresal Intrathecal - see baclofen
Loniten - see minoxidil
lopinavir/ritonavir, capsule, 133.3mg/33.3mg; oral solution, 80mg/20mg(mL)
(Kaletra-ABB)
Losec - see omeprazole
Lovenox - see enoxaparin
Lupron Depot - see leuprolide acetate
Maxalt - see rizatriptan benzoate
Maxalt RPD - see rizatriptan benzoate
Med-Cyclobenzaprine - see cyclobenzaprine HCl
Med-Minocycline - see minocycline HCl
Med-Selegiline - see selegiline HCl
Megace - see megestrol acetate tablet
Megace OS - see megestrol acetate oral suspension
*megestrol acetate, tablet, 40mg, 160mg (Megace-BRI) (Lin-Megestrol-LIN) (ApoMegestrol-APX) (Nu-Megestrol-NXP)
For treatment of anorexia, cachexia or an unexplained weight loss in patients with a
diagnosis of acquired immunodeficiency (AIDS).
megestrol acetate, oral suspension (Megace OS-BRI)
For treatment of anorexia, cachexia or an unexplained weight loss in patients with a
diagnosis of acquired immunodeficiency syndrome (AIDS) who are unable to tolerate
tablets.
242
meloxicam, tablet, 7.5mg, 15mg (Mobicox-BOE)
•
•
•
Formulary.
Mepron - see atovaquone
mercaptopurine, tablet, 50mg (Purinethol-GSK)
(a) For treatment of Crohn's Disease.
(b) For treatment of rheumatoid arthritis.
+methoxsalen, capsule, 10mg (Oxsoralen-ICN) (Oxsoralen Ultra-ICN) (UltramopCDX); lotion, 1% (Oxsoralen-ICN) (Ultramop-CDX)
For treatment of psoriasis, for use prior to PUVA therapy.
methysergide maleate, tablet, 2mg (Sansert-NVR)
For prophylaxis of recurrent vascular headaches. Coverage will be provided for up to
6 months at a time with a 3-4 week medication free interval between courses of
therapy.
Miacalcin - see calcitonin salmon nasal spray
midodrine HCl, tablet, 2.5mg, 5mg (Amatine-RBP)
For treatment of orthostatic hypotension.
Minocin - see minocycline HCl
* minocycline HCl, capsule, 50mg, 100mg (Minocin-WYA) (Apo-Minocycline-APX)
(Novo-Minocycline-NOP) (ratio-Minocycline-RTP) (Gen-Minocycline-GPM)
(Med-Minocycline-MED) (Dom-Minocycline-DOM) (Rhoxal-Minocycline-RHO) (pmsMinocycline-PMS)
For treatment of acne unresponsive to tetracycline.
minoxidil, tablet, 2.5mg, 10mg (Loniten-PHU)
For control of hypertension unresponsive to all other listed therapeutic agents.
Mobicox – see meloxicam
modafinil, tablet, 100mg (Alertec-DPY)
For treatment of narcolepsy and idiopathic CNS hypersomnia in patients whose
symptoms of daytime sleepiness are not controlled on methylphenidate or
dextroamphetamine.
Monocor - see bisoprolol fumarate
montelukast sodium, chewable tablet, 4mg, 5mg; tablet, 10mg (Singulair-MSD)
For adjunctive treatment of asthma in patients not well controlled on inhaled
corticosteroids.
243
Monurol - see fosfomycin tromethamine
moxifloxacin HCl, tablet, 400mg (Avelox-BAY)
For treatment of:
not appropriate.
Mycobutin - see rifabutin
mycophenolate mofetil, capsule, 250mg; tablet, 500mg (CellCept-HLR)
For prevention of acute rejection in transplant patients.
nabilone, capsule, 1mg (Cesamet-LIL)
For treatment of nausea and anorexia in AIDS patients.
*nabumetone, tablet, 500mg (Relafen-GSK) (Apo-Nabumetone-APX) (GenNabumetone-GPM) (Novo-Nabumetone-NOP) (Rhoxal-Nabumetone-RHO); 750mg
(Relafen-GSK) (Novo-Nabumetone-NOP)
For treatment of patients with an intolerance to other NSAIDs listed in the Formulary.
nadroparin calcium, syringe, 9,500IU/mL (0.3mL, 0.4mL, 0.6mL, 0.8mL, 1.0mL)
(Fraxiparine-SAW); syringe, 19,000IU/mL (0.6mL, 0.8mL, 1mL) (Fraxiparine ForteSAW)
syndrome.
nafarelin acetate, intranasal solution, 2mg/mL (Synarel-HLR)
months.
Nalcrom - see sodium cromoglycate
naratriptan HCl, tablet, 1mg, 2.5mg (Amerge-GSK)
For treatment of migraine headaches. Eligibility will be restricted to beneficiaries over
18 and under 65 years of age.
The maximum quantity that can be claimed through the Drug Plan is limited to 6
doses per 30 days within a 60 day period. Patients requiring more than 12 doses in
a consecutive 60 day period should be considered for migraine prophylaxis therapy if
they are not already receiving such therapy.
nateglinide, tablet, 60mg, 120mg, 180mg (Starlix-NVR)
For treatment of diabetes in patients who are not adequately controlled on or are
intolerant to sulfonylureas.
244
nelfinavir mesylate, tablet, 250mg; oral powder, 50mg/g (Viracept-AGR)
Neoral - see cyclosporine
Neupogen - see filgrastim
nevirapine, tablet, 200mg (Viramune-BOE)
nimodipine, capsule, 30mg (Nimotop-BAY)
For treatment of subarachnoid hemorrhage to complete a 3 week course of treatment
in cases where a patient is discharged from hospital before completion of the
treatment period.
Nimotop - see nimodipine
Nizoral - see ketoconazole
norfloxacin, ophthalmic solution, 0.3% (Noroxin Ophthalmic Solution-MSD)
For treatment of ophthalmic infections caused by gram-negative organisms or those
not responding to alternative agents.
* norfloxacin, tablet, 400mg (Noroxin-MSD) (Apo-Norflox-APX) (Novo-Norfloxacin-NOP)
For treatment of:
(a) Genitourinary tract infections caused by Pseudomonas aeruginosa.
(b) Adults with gonoccoccal urethritis or cervicitis.
(c) Genitourinary tract infections in patients allergic to alternative agents.
(d) Genitourinary tract infections with organisms known to be resistant to alternative
antibiotics.
Noroxin - see norfloxacin
Norvir - see ritonavir
Norvir SEC - see ritonavir
NovoRapid - see insulin aspart
Novo-Cefaclor - see cefaclor
Novo-Cycloprine - see cyclobenzaprine HCl
Novo-Cyproterone - see cyproterone acetate
Novo-Ketoconazole - see ketoconazole
Novo-Ketotifen - see ketotifen fumarate
Novo-Minocycline - see minocycline HCl
Novo-Nabumetone - see nabumetone
Novo-Norfloxacin - see norfloxacin
Novo-Selegiline - see selegiline HCl
Nu-Cefaclor - see cefaclor
Nu-Cyclobenzaprine - see cyclobenzaprine HCl
Nu-Ketocon - see ketoconazole
Nu-Ketotifen - see ketotifen fumarate
245
Nu-Megestrol - see megestrol acetate tablet
Nu-Selegiline - see selegiline HCl
Nu-Ticlopidine - see ticlopidine HCl
Nutropin - see somatropin
Nutropin AQ - see somatropin
Octostim – see desmopressin
octreotide, injection, 50ug/mL (1mL), 100ug/mL (1mL), 200ug/mL (5mL),
500ug/mL (1mL) (Sandostatin-NVR); powder for injection, 10mg/vial, 20mg/vial,
30mg/vial (Sandostatin LAR-NVR)
(a) For management of terminal malignant bowel obstruction in palliative patients.
(b) For treatment of acromegaly.
Note: Coverage for federally approved cancer indications is provided under the
Saskatchewan Cancer Foundation according to their guidelines.
Ocufen - see flurbiprofen sodium
Ocuflox - see ofloxacin ophthalmic solution
Oesclim - see estradiol
ofloxacin, ophthalmic solution, 0.3% (Ocuflox-ALL)
(a) For treatment of ophthalmic infections caused by gram-negative organisms or
those not responding to alternative agents.
(b) For treatment of infiltrative corneal infections.
olanzapine, tablet, 2.5mg, 5mg, 7.5mg, 10mg, 15mg (Zyprexa-LIL); orally
disintegrating tablet, 5mg, 10mg (Zyprexa Zydis-LIL)
(a) For treatment of schizophrenia.
(b) For treatment of other psychotic conditions where there has been treatment
failure or intolerance to other atypical anti-psychotic agents.
omeprazole, delayed release tablet, 10mg (Losec-AST)
(a) For maintenance therapy of healed reflux esophagitis. This is renewable on a
yearly basis.
resolution.
(c) For first-line prevention of gastroduodenal hemorrhage in high risk patients with
246
omeprazole, enteric coated tablet, 20mg (Losec-AST)
misoprostol.
resolution.
failures.
One-Alpha - see alfacalcidol
Oxeze Turbuhaler - see formoterol fumarate
Oxsoralen - see methoxsalen
*pamidronate disodium injection, 30mg, 90mg (Aredia-NVR) (Pamidronate
Disodium Injection-DBU);
60mg (Pamidronate Disodium Injection-DBU)
For treatment of osteoporosis in patients unable to tolerate oral bisphosphonates.
pantoprazole, enteric coated tablet, 40mg (Pantoloc-SLV)
misoprostol.
resolution.
failures.
Pantoloc - see pantoprazole
247
Pariet - see rabeprazole sodium
PEG-Intron - see peginterferon alfa-2b
peginterferon alfa-2b, powder for injection (vial), 50ug/0.5mL, 80ug/0.5mL,
120ug/0.5mL, 150ug/0.5mL (PEG-Intron-SCH)
For treatment of chronic active hepatitis C. Coverage will be provided for an initial 6
month period with potential renewal for 2 additional 6 month periods.
pentosan polysulfate sodium, capsule, 100mg (Elmiron-JAN)
For treatment of interstitial cystitis where other treatments have failed.
Persantine - see dipyridamole
pioglitazone HCl, tablet, 15mg, 30mg, 45mg (Actos-LIL)
intolerant to metformin or sulfonylureas.
pivmecillinam HCl, tablet, 200mg (Selexid-LEO)
For treatment of:
(a) Urinary tract infections with organisms resistant to first line therapy.
(b) Urinary tract infections in patients allergic to first line agents.
(c) Urinary tract infections in pregnancy when first line agents are inappropriate.
Plavix - see clopidogrel bisulfate
pms-Bezafibrate - see bezafibrate
pms-Carbamazepine-CR - see carbamazepine
pms-Cefaclor - see cefaclor
pms-Cyclobenzaprine - see cyclobenzaprine HCl
pms-Deferoxamine - see deferoxamine mesylate
pms-Fluconazole - see fluconazole
pms-Ketotifen - see ketotifen
pms-Lactulose - see lactulose
pms-Minocycline - see minocycline HCl
pms-Ticlopidine - see ticlopidine HCl
pms-Tobramycin – see tobramycin
pms-Vancomycin - see vancomycin HCl
Prevacid - see lansoprazole
Profasi HP - see chorionic gonadotropin
progesterone (micronized), capsule, 100mg (Prometrium-SCH)
(a) For treatment of patients unable to tolerate medroxyprogesterone acetate
(Provera).
(b) For treatment of patients having low high-density lipoproteins.
Prograf - see tacrolimus
Prometrium - see progesterone (micronized)
Protopic - see tacrolimus
Protropin - see somatrem
Pulmozyme - see dornase alfa
Purinethol - see mercaptopurine
248
quetiapine, tablet, 25mg, 100mg, 150mg, 200mg, 300mg (Seroquel-AST)
(a) For treatment of schizophrenia.
(b) For treatment of other psychotic conditions where there has been treatment
failure or intolerance to other atypical anti-psychotic agents.
(c) For treatment of psychosis caused by drugs used in the treatment of Parkinson's
Disease.
rabeprazole sodium, tablet, 10mg (Pariet-JAN)
misoprostol. Coverage for a repeat treatment with be approved only after a 3-6
misoprostol.
resolution.
failures.
(e) First-line prevention of gastroduodenal hemorrhage in high risk patients with prior
history of gastroduodenal bleeds for whom anticoagulant, glucocorticosteroid or
NSAID therapy cannot be avoided. Coverage is renewable on a yearly basis for
patients if discontinuation of offending agents or replacement with less damaging
alternatives is not feasible.
raloxifene HCl, tablet, 60mg (Evista-LIL)
(a) For treatment of osteoporosis in women unable to tolerate listed
bisphosphonates.
(b) For treatment of osteoporosis in women who do not respond to listed
bisphosphonates after receiving treatment for one year.
Rapamune - see sirolimus
ratio-Amoxi Clav - see amoxicillin trihydrate/potassium clavulanate
ratio-Cefuroxime - see cefuroxime axetil
ratio-Lactulose - see lactulose
ratio-Minocycline - see minocycline HCl
Rebetron - see interferon alfa-2b/ribavirin
Rebif - see Appendix J
Relafen - see nabumetone
Remicade - see infliximab
Reminyl - see galantamine hydrobromide
Renagel - see sevelamer HCl
repaglinide, tablet, 0.5mg, 1mg, 2mg (GlucoNorm-NOO)
Intolerant to sulfonylureas.
Rescriptor - see delavirdine mesylate
Retin A - see tretinoin
Retrovir - see zidovudine
249
Rhoxal-Minocycline - see minocycline HCl
Rhoxal-Nabumetone - see nabumetone
Rhoxal-Ticlopidine - see ticlopidine HCl
rifabutin, capsule, 150mg (Mycobutin-PHU)
For prevention of disseminated Mycobacterium avium complex (MAC) disease in
patients with advanced human immunodeficiency virus (HIV) infection.
risedronate sodium, tablet, 5mg (Actonel-PGA)
disodium/calcium (Didrocal) after receiving it for one year.
(c) For treatment of osteoporosis in patients who have fresh fractures.
risedronate sodium, tablet, 30mg (Actonel-PGA)
For treatment of symptomatic Paget's Disease of the bone.
ritonavir, oral solution, 80mg/mL (Norvir-ABB); soft elastic capsule, 100mg (Norvir
SEC-ABB)
rivastigmine, capsule, 1.5mg, 3mg, 4.5mg, 6mg (Exelon-NVR)
are not to be used concurrently with rivastigmine therapy. List all current
medications patient was taking at the time of assessment.
•
Eligible patients currently taking rivastigmine would require assessment at 6
month intervals. To continue receiving rivastigmine, patients must not have both
a greater than 2 point reduction in MMSE and a 1 point increase in FAQ in a 6
•
Eligible new patients will enter a 3 month treatment period with rivastigmine.
During the 3 month trial, patients must exhibit an improvement from the initial
MMSE or FAQ to continue treatment with rivastigmine. The improvement must
be at least 2 MMSE points or -1 FAQ. Patients who meet these requirements will
be re-evaluated at 6 month intervals. To continue receiving rivastigmine, patients
must not have both a greater than 2 point reduction in MMSE and a 1 point
increase in FAQ in a 6 month evaluation period. Scores are compared to the
most recent test results.
•
coverage.
•
Patients who do not meet criteria to continue rivastigmine can be re-evaluated
within 3 months to confirm deterioration before coverage is discontinued.
•
Rivastigmine does not need to be discontinued prior to MMSE or FAQ testing.
250
•
•
this class.
Applications for EDS for rivastigmine (Exelon) will only be accepted from physicians
on the Aricept/Exelon/Reminyl EDS application form. This form is available on-line at
http://formulary.drugplan.health.gov.sk.ca or by calling the Drug Plan.
rizatriptan benzoate, tablet, 5mg, 10mg (Maxalt-MSD); wafer, 5mg, 10mg
(Maxalt RPD-MSD)
Rocaltrol - see calcitriol
rofecoxib, tablet, 12.5mg, 25mg; oral suspension, 2.5mg/mL (Vioxx-MSD)
•
•
•
Formulary.
Roferon-A - see interferon alfa-2a
rosiglitazone maleate, tablet, 2mg, 4mg, 8mg (Avandia-GSK)
intolerant to metformin or sulfonylureas.
SAB-Tobramycin - see tobramycin ophthalmic solution
Saizen - see somatropin
salmeterol xinafoate, metered dose inhaler, 25ug/actuation; powder disk,
50ug/blister (Serevent-GSK); powder for inhalation (package), 50ug/dose (Serevent
Diskus-GSK)
(a) For treatment of asthma uncontrolled on concurrent inhaled steroid therapy.
It is important that these patients also have access to a short-acting beta-2
agonist for symptomatic relief.
(b) For treatment of Chronic Obstructive Pulmonary Disease (COPD).
251
salmeterol xinafoate/fluticasone propionate, metered dose inhaler (package),
25ug/125ug, 25ug/250ug (Advair-GSK); powder for inhalation (package),
50ug/100ug, 50ug/250ug, 50ug/500ug (Advair Diskus-GSK)
(a) For treatment of asthma in patients not adequately controlled on inhaled steroid
therapy. It is important that these patients also have access to a short-acting
beta-2 agonist for symptomatic relief.
(b) For treatment of chronic obstructive pulmonary disease (COPD) in patients who
are not adequately controlled on long-acting beta-2 agonists alone.
Sandostatin - see octreotide
Sandostatin LAR - see octreotide
Sansert - see methysergide maleate
saquinavir, capsule, 200mg (Invirase-HLR); soft gelatin capsule, 200mg
(Fortovase-HLR)
*selegiline HCl, tablet, 5mg (Eldepryl-DPY) (Novo-Selegiline-NOP)
(Apo-Selegiline-APX) (Gen-Selegiline-GPM) (Med-Selegiline-MED)
(Nu-Selegiline-NXP) (Dom-Selegiline-DOM)
(a) For use as an adjunct in cases of Parkinson's Disease being treated with
levodopa, levodopa/benzerazide, levodopa/carbidopa, or bromocriptine.
(b) For prophylaxis in early Parkinsonism.
Selexid - see pivmecillinam HCl
Serevent - see salmeterol xinafoate
Serevent Diskus - see salmeterol xinafoate
Seroquel – see quetiapine
sevelamer HCl, tablet, 400mg, 800mg (Renagel-GZY)
(a) For treatment of patients in endstage renal disease with intolerance to aluminum
or calcium containing phosphate binding agents.
(b) For treatment of patients in endstage renal disease where aluminum or calcium
containing phosphate binding agents are inappropriate.
Sibelium - see flunarizine HCl
Singulair – see montelukast sodium
sirolimus, oral solution, 1mg/mL (Rapamune-WYA)
For prophylaxis of graft rejection in transplant patients.
sodium cromoglycate, capsule, 100mg (Nalcrom-AVT)
(a) For treatment of patients who experience severe reactions to foods which cannot
be avoided.
(b) For treatment of patients with Crohn's Disease or ulcerative colitis not responding
to traditional therapy.
somatrem, injection, 5mg, 10mg (Protropin-HLR)
For treatment of children who have growth failure due to inadequate secretion of
normal endogenous growth hormone.
252
+somatropin, injection, 5mg (Humatrope-LIL), 6mg, 12mg (Humatrope CartridgeLIL)
normal endogenous growth hormone.
+somatropin, injection, 3.33mg (Saizen-SRO), 5mg (Nutropin-HLR) (Saizen-SRO),
10mg (Nutropin AQ-HLR)
normal endogenous growth hormone, or who have growth failure associated with
chronic renal insufficiency. Note: Exception Drug Status coverage is not required for
S.A.I.L. patients, coverage is provided under the Saskatchewan Aids to Independent
Living (S.A.I.L.) Program.
Soriatane - see acitretin
Sporanox - see itraconazole
Starlix - see nateglinide
stavudine, capsule, 15mg, 20mg, 30mg, 40mg (Zerit-BRI)
Stieva-A Forte - see tretinoin
sumatriptan, tablet, 25mg, 50mg, 100mg; injection solution, 6mg/0.5mL; nasal
spray, 5mg, 20mg (Imitrex-GSK)
Suprax - see cefixime
Suprefact - see buserelin acetate
Sustiva - see efavirenz
Symbicort Turbuhaler - see formoterol fumarate dihydrate/budesonide
Synarel - see nafarelin acetate
3TC - see lamivudine
tacrolimus, capsule, 0.5mg, 1mg, 5mg; ampoule, 5mg/mL (Prograf-FUJ)
For prophylaxis of graft rejection.
tacrolimus, topical ointment, 0.03%, 0.1% (Protopic-FUJ)
For treatment of moderate to severe atopic dermatitis in patients who are
unresponsive or intolerant to topical steroids.
Taro-Carbamazepine CR – see carbamazepine
Tequin - see gatifloxacin
Tegretol CR - see carbamazepine
Ticlid - see ticlopidine HCl
253
*ticlopidine HCl, tablet, 250mg (Ticlid-HLR) (Apo-Ticlopidine-APX) (Nu-TiclopidineNXP) (Gen-Ticlopidine-GPM) (pms-Ticlopidine-PMS) (Dom-Ticlopidine-DOM)
(Rhoxal-Ticlopidine-RHO)
(a) For treatment of patients who have experienced a recurrent vascular episode
while on acetylsalicylic acid.
(b) For treatment of patients who have experienced a recurrent vascular episode
and have a clearly demonstrated allergy to acetylsalicylic acid (manifested by
asthma or nasal polyps).
(c) For treatment of patients who have experienced a recurrent vascular episode
and are intolerant of acetylsalicylic acid (manifested by gastrointestinal
hemorrhage).
(d) When prescribed following intracoronary stent placement. Coverage will be
provided for a period of 4 weeks.
tinzaparin sodium, syringe, 10,000IU/mL (0.35mL, 0.45mL), 20,000IU/mL (0.5mL,
0.7mL, 0.9mL); injection solution, 10,000IU/mL (2mL), 20,000IU/mL (2mL) (InnohepLEO)
syndrome.
tizanidine HCl, tablet, 4mg (Zanaflex-DPY)
For treatment of patients with severe spasticity who are unresponsive or intolerant to
baclofen or benzodiazepines.
TOBI - see tobramycin inhalation solution
Tobradex - see tobramycin/dexamethasone
Tobramycin - see tobramycin ophthalmic solution
tobramycin, inhalation solution, 60mg/mL (TOBI-PCL)
For treatment of cystic fibrosis patients who do not tolerate injectable tobramycin
when used for inhalation.
tobramycin, ophthalmic ointment, 0.3% (Tobrex-ALC);
*ophthalmic solution, 0.3% (Tobrex-ALC) (pms-Tobramycin-PMS) (TobramycinRVX) (SAB-Tobramycin-SAB)
For treatment of ophthalmic infections in cases not responding to gentamicin
ophthalmic.
tobramycin/dexamethasone, ophthalmic suspension, 0.3%/0.1%; ophthalmic
ointment, 0.3%/0.1% (Tobradex-ALC)
(a) For treatment of ophthalmic infections in cases not responding to therapeutic
alternatives.
(b) For post-operative long-term (>7days) use.
Tobrex - see tobramycin
tolterodine l-tartrate, extended-release capsule, 2mg, 4mg (Unidet-PHU)
For treatment of patients unable to tolerate oxybutynin chloride.
254
tolterodine l-tartrate, tablet, 1mg, 2mg (Detrol-PHU)
Note: Detrol is scheduled to be delisted from the Saskatchewan Formulary
effective April 1, 2003.
For treatment of patients unable to tolerate oxybutynin chloride.
Tracleer - see bosentan
*tretinoin, cream, 0.1% (Stieva-A Forte-STI) (Retin A-JAN) (Vitamin A Acid-DER)
For treatment of acne not responding to alternative topical therapy.
triamcinolone hexacetonide, injection suspension, 20mg/mL (Aristospan-STI)
For intra-articular injection in the management of pediatric chronic inflammatory
arthropathies.
Trizivir - see abacavir SO4/lamivudine/zidovudine
Ultradol - see etodolac
Ultramop - see methoxsalen
Ultravate - see halobetasol propionate
Unidet - see tolterodine l-tartrate
Urispas - see flavoxate HCl
Urso - see ursodiol
ursodiol, tablet, 250mg (Urso-AXC)
For management of cholestatic liver diseases such as primary biliary cirrhosis.
Vancocin - see vancomycin HCl
vancomycin HCl, capsule, 125mg, 250mg, (Vancocin-LIL)
* injection, 500mg, 1g (Vancocin-LIL) (pms-Vancomycin-PMS)
For treatment of:
Clostridium difficile infections for up to two consecutive two week periods after
noresponse, allergies or intolerance to a course of metronidazole. Repeat approvals
will only be granted with laboratory evidence of C. difficile toxin.
Videx - see didanosine
Videx EC - see didanosine
Vioxx - see rofecoxib
Viracept – see nelfinavir mesylate
Viramune – see nevirapine
Vitamin A Acid - see tretinoin
Vivelle - see estradiol
Voltaren Ophtha - see diclofenac sodium
Wellbutrin SR – see bupropion HCl
Zaditen - see ketotifen fumarate
zafirlukast, tablet, 20mg (Accolate-AST)
(a) For treatment of asthma when used in patients on concurrent steroid therapy.
(b) For treatment of asthma in patients not well controlled with inhaled
corticosteroids.
zalcitabine, tablet, 0.375mg, 0.750mg (Hivid-HLR)
255
Zanaflex - see tizanidine HCl
Zerit - see stavudine
Ziagen - see abacavir SO4
zidovudine, syrup, 10mg/mL; injection, 10mg/mL (Retrovir-GSK)
*capsule, 100mg (Retrovir-GSK) (Apo-Zidovudine-APX)
Zithromax - see azithromycin
Zoladex - see goserelin acetate
zolmitriptan, tablet, 2.5mg (Zomig-AST); orally dispersible tablet, 2.5mg
(Zomig Rapimelt-AST)
Zomig - see zolmitriptan
Zomig Rapimelt - see zolmitriptan
zuclopenthixol, acetate injection, 50mg/mL (Clopixol-Acuphase-AVT); decanoate
injection, 200mg/mL (Clopixol-Depot-AVT); dihydrochloride tablet, 10mg, 25mg,
40mg (Clopixol-AVT)
For treatment of patients with schizophrenia not responding to other neuroleptic
medications.
Zyprexa - see olanzapine
Zyprexa Zydis - see olanzapine
Zyvoxam - see linezolid
LEGEND:
*These brands of products have been approved as interchangeable.
+These brands of products have NOT been approved as interchangeable.
256
SORIATANE
Important Information for Female Patients:
Soriatane can cause deformed babies if it is taken by a female before or during
pregnancy.
•
Do not take Soriatane if you are or may become pregnant during treatment or for an
undetermined period of time* after treatment has stopped.
•
You must avoid becoming pregnant while you are taking Soriatane and for an
undetermined period of time* after you stop taking Soriatane.
•
You must discuss effective birth control with your doctor before beginning treatment
and you must use effective birth control: for at least 1 month before you start
Soriatane; while you are taking Soriatane; and for an undetermined period of time*
after you stop taking Soriatane, bearing in mind that any method of birth control can
fail.
•
It is recommended that you either abstain from sexual intercourse or use 2 reliable
methods of birth control at the same time.
•
Do not take Soriatane until you are sure that you are not pregnant: you must have a
serum pregnancy test within 2 weeks before you start Soriatane; you must wait until
the second or third day of your next menstrual period before you start Soriatane.
•
Contact your doctor immediately if you do become pregnant while taking Soriatane or
after treatment has stopped. You should discuss with your doctor the serious risk of
your baby having severe birth deformities because you are taking or have taken
Soriatane. You should also discuss the desirability of continuing your pregnancy.
•
Do not breast feed while taking Soriatane or for an extended period of time after
treatment has stopped.
*
Soriatane remains in your body for prolonged periods of time after you have
stopped treatment. It is not known exactly how long you must avoid pregnancy
after Soriatane is stopped. The drug has been found in the blood of some
patients for at least 2 years following treatment. Discuss this with your doctor.
Talk with your doctor before you stop birth control.
Important Information for All Patients:
Soriatane can cause deformed babies if taken by a female before or during
pregnancy.
•
Do not give Soriatane to anyone else who has similar symptoms.
•
Do not donate blood, while you are taking Soriatane or for an extended period of time
after treatment has stopped. This is because your blood should not be given to a
pregnant female.
•
Do not consume alcohol while taking Soriatane.
257
APPENDIX B
HOSPITAL BENEFIT DRUG LIST
OCTOBER 2002
NOTIFICATION OF UPDATES TO THE HOSPITAL BENEFIT DRUG LIST
WILL BE PROVIDED IN THE DRUG PLAN UPDATE BULLETINS
PLEASE DIRECT INQUIRIES REGARDING THIS LIST TO:
(306) 787- 3224
259
1.
This list of drug benefits under Saskatchewan Health is supplementary to the annual
nd
Saskatchewan Formulary (52 Edition, October 2002). It is intended to expand on
the Formulary as required to meet the special requirements of hospitals.
2.
The Benefit Drug List is updated semi-annually by the Advisory Committee on
Institutional Pharmacy Practice. This committee is composed of representatives of:
the Canadian Society of Hospital Pharmacists (Saskatchewan Branch); the Drug
Quality Assessment Committee; the Saskatchewan Association of Health
Organizations and officials of the Department of Health. The new additions to the list
are presented in bold type.
3.
In summary, the government is accepting the following items as insured benefits
under The Saskatchewan Hospitalization Act when administered to patients in
hospital. Institutional formularies put in place by Regional Health Authorities may
affect the availability of some insured drugs:
(a)
"All products listed in the Saskatchewan Formulary." (Brands other than
those listed are not considered as interchangeable.)
(b)
Unlisted strengths of products included in the Saskatchewan Formulary or
approved for Exception Drug Status coverage (see item 5). [This applies
only to brands manufactured by the same supplier(s).]
(c)
Generally accepted nursing treatments, agents such as antiseptics,
disinfectants, mouthwashes, lozenges, lubricants, soaps and emollients.
(d)
All diagnostic agents.
(e)
All irrigating solutions.
(f)
All radioactive agents.
(g)
All injectable vitamins and injectable multivitamin preparations when used
to maintain or attain nutritional status.
(h)
Alcoholic beverages such as beer, stout, brandy and whiskey.
(i)
All dietary supplements.
(j)
All antacids and laxatives marketed by approved manufacturers.
(k)
All hemostatic agents.
(l)
All agents appearing on the attached supplemental list including all dosage
forms and strengths unless otherwise indicated in the list. Prolonged
release, sustained release, and delayed release dosage forms are benefits
only when specifically listed.
(m) New dosage forms, drug entities and other products released on the
market after the effective date of this list are not insured hospital benefits.
They may be charged to hospital clients until reviewed and approved as
an insured benefit by the Saskatchewan Formulary Committee or the
Advisory Committee on Institutional Pharmacy Practice.
4.
Formularies established by health facilities or Regional Health Authorities may not
include all insured items. If an insured drug is not included in a facility or health
260
region formulary, its provision will be subject to facility or Regional Health Authority
policy.
5.
Only drugs listed in the Saskatchewan Formulary, and not those on the Benefit Drug
List, are an insured benefit when dispensed to ambulatory patients, i.e. through retail
pharmacies or an organized hospital dispensing service.
6.
For certain patients, the Prescription Drug Services Branch may approve/has
approved Exception Drug Status coverage, on an outpatient basis, for certain
products which are not listed in the Saskatchewan Formulary or the Benefit Drug
List. Patients with such coverage have been issued a letter of authorization which,
upon presentation in a hospital, also entitles the beneficiary to receive the specified
drug as an inpatient benefit (notwithstanding Statement 4 above).
In cases where treatment with a product known to be eligible for Exception Drug
Status Coverage is initiated in the hospital, it will be recognized as an inpatient
benefit providing the patient's case meets the eligibility criteria listed in the
Saskatchewan Formulary. The drugs eligible for such coverage and the criteria for
patient eligibility are published in the Saskatchewan Formulary as Appendix A.
7.
Certain products are benefits only when used according to specific criteria. The
usage criteria or restrictions that apply are shown for each product. When these
products are ordered, the ordering physician and/or the pharmacist must determine if
the conditions for coverage have been met. When the conditions are met, the
patient receives the drug as a benefit. The cost is absorbed by the health region.
The region may choose to charge the patient for administration of drugs in this
section that fails to meet the criteria/restrictions listed.
8.
Combination products are only benefits if they are specifically included in the Benefit
Drug List. Listing of one ingredient included in a combination product does not make
that product a benefit.
9.
Products that are not listed in either the Saskatchewan Formulary or this
supplementary benefit drug list, or which have not received special approval, are not
insured and therefore chargeable to a patient in accordance with instructions
included in Statement 137.
10. Certain products may be granted Restricted Coverage status for non-approved
indications. This is the case only when the Advisory Committee for Institutional
Pharmacy Practice has reviewed evidence to demonstrate safety and efficacy and
the prescriber is aware the drug is being prescribed for a non-approved indication.
11. EprexTM, Iron Dextran and VenoferTM may be billed to the Drug Plan when used for
the treatment of anemia of renal disease if patients receive these drugs in an
institution’s dialysis unit as an outpatient. The cost of EprexTM, Iron Dextran and
VenoferTM for inpatient use is the responsibility of the health region.
Payment Policy Statement:
•
The Drug Plan will reimburse hospital pharmacies the actual acquisition cost
(AAC) of the dose of EprexTM, Iron Dextran or VenoferTM that is administered
plus a 10% mark-up for each month’s supply. The mark-up will be capped at
$20.00 per month, unless there are dosage changes.
How to bill the Drug Plan:
•
To ensure consistency in billing for these agents, hospital pharmacy
departments are asked to use specific billing forms to submit claims. Please
contact (306) 787-3315 or toll free 1-800-667-7578 with any questions.
261
TABLE OF CONTENTS
04:00.00
ANTIHISTAMINE DRUGS
266
08:00.00
ANTI INFECTIVE AGENTS
266
8:12.00
ANTIBIOTICS
08:12.02
08:12.04
08:12.06
08:12.07
08:12.08
08:12.12
08:12.28
266
AMINOGLYCOSIDES
ANTIFUNGALS
CEPHALOSPORINS
MISCELLANEOUS BETA LACTAM ANTIBIOTICS
CHLORAMPHENICOL
ERYTHROMYCINS
MISCELLANEOUS ANTIBIOTICS
266
266
266
267
267
267
268
08:16.00
ANTITUBERCULOSIS AGENTS
268
08:18.00
ANTIVIRALS
268
08:22.00
QUINOLONES
268
08:40.00
MISCELLANEOUS ANTI INFECTIVES
269
10:00.00
ANTINEOPLASTIC AGENTS (AGENTS USED FOR NON-CANCER
INDICATIONS. SEE FORMULARY OF THE SASKATCHEWAN CANCER
FOUNDATION FOR A COMPLETE LISTING OF ANTINEOPLASTIC AGENTS.)
269
12:00.00
AUTONOMIC DRUGS
269
12:04.00
PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
269
12:08.00
ANTICHOLINERGIC AGENTS
12:08.08
269
ANTIMUSCARINIC/ANTISPASMODICS
269
12:12.00
SYMPATHOMIMETIC (ADRENERGIC) AGENTS
270
12:16.00
SYMPATHOLYTICS
270
12:20.00
SKELETAL MUSCLE RELAXANTS
270
20:00.00
270
20:04.00
ANTIANEMIA DRUGS
270
20:04.04
IRON PREPARATIONS
270
20:12.00
COAGULANTS AND ANTICOAGULANTS
271
262
20:12.04
20:12.08
20:12.16
20:40.00
24:00.00
ANTICOAGULANTS
ANTIHEPARIN AGENTS
HEMOSTATICS
THROMBOLYTIC AGENTS
271
271
271
272
272
24.04.00
CARDIAC DRUG
272
24:08.00
HYPOTENSIVE AGENTS
273
24:12.00
VASODILATING AGENTS
273
28:00.00
CENTRAL NERVOUS SYSTEM AGENTS
28:04.00
GENERAL ANESTHETICS
28:08.00
ANALGESICS AND ANTIPYRETICS
28:08.04
28:08.08
28:08.12
28:08.92
NON-STEROIDAL ANTI-INFLAMMATORY AGENTS
OPIATE AGONISTS
OPIATE PARTIAL AGONISTS
MISCELLANEOUS ANALGESICS AND ANTIPYRETICS
273
273
273
274
274
274
274
28:10.00
OPIATE ANTAGONISTS
274
28:12.00
ANTICONVULSANTS
274
28:16.00
PSYCHOTHERAPEUTIC AGENTS
28:16.08
28:24.00
TRANQUILIZERS
ANXIOLYTICS, SEDATIVES AND HYPNOTICS
28:24.04 BARBITURATES
28:24.08 BENZODIAZEPINES
28:24.92 MISCELLANEOUS ANXIOLYTICS, SEDATIVES AND
HYPNOTICS
36:00.00
36:56.00
40:00.00
274
274
DIAGNOSTIC AGENTS
275
275
275
275
275
MYASTHENIA GRAVIS
275
ELECTROLYTIC, CALORIC AND WATER BALANCE
275
40:08.00
ALKALINIZING AGENTS
275
40:20.00
CALORIC AGENTS
276
40:28.00
DIURETICS
276
263
44:00.00
ENZYMES
276
48:00.00
ANTITUSSIVES, EXPECTORANTS AND MUCOLYTIC AGENTS
276
48:08.00
ANTITUSSIVES
277
48:16.00
EXPECTORANTS
277
52:00.00
EYE, EAR, NOSE AND THROAT PREPARATIONS
52:04.00
ANTI-INFECTIVES
52:04.04
277
277
ANTIBIOTICS
277
52:16.00
LOCAL ANESTHETICS
277
52:20.00
MIOTICS
277
52:24.00
MYDRIATICS
277
52:32.00
VASOCONSTRICTORS
278
52:36.00
MISCELLANEOUS EYE, EAR, NOSE AND THROAT DRUGS
278
56:08.00
ANTIDIARRHEA AGENTS
278
56:12.00
CATHARTICS AND LAXATIVES
278
56:20.00
EMETICS
279
56:22.00
ANTIEMETICS
279
56:40.00
MISCELLANEOUS GASTROINTESTINAL DRUGS
279
64:00.00
HEAVY METAL ANTAGONISTS
279
68:00.00
HORMONES AND SYNTHETIC SUBSTITUTES
279
68:04.00
ADRENALS
279
68:08.00
ANDROGENS
280
68:28.00
PITUITARY
280
72:00.00
LOCAL ANESTHETICS
280
72:00.00
OXYTOCICS
280
80:00.00
SERUMS, TOXOIDS AND VACCINES
281
264
80:04.00
SERUMS
281
80:08.00
TOXOIDS
281
80:12.00
VACCINES
282
84:00.00
SKIN AND MUCOUS MEMBRANE AGENTS
84:04.00
ANTI INFECTIVES
84:04.04
84:04.16
282
282
ANTIBIOTICS
MISCELLANEOUS LOCAL ANTI-INFECTIVES
282
282
84:08.00
ANTI PRURITICS AND LOCAL ANESTHETICS
283
84:24.00
EMOLLIENTS, DEMULCENTS AND PROTECTANTS
283
84:40:00
HEMORRHOID PREPARATIONS
283
88:00.00
88:16.00
92:00.00
VITAMINS
283
VITAMIN D
283
265
284
04:00.00
ANTIHISTAMINE DRUGS
CYPROHEPTADINE
Tablet 4mg
Syrup 0.4mg/mL
DIPHENHYDRAMINE (injection only)
Injection 50mg/mL
PROMETHAZINE
Injection 25mg/mL
08:00.00
ANTI INFECTIVE AGENTS
8:12.00
ANTIBIOTICS
08:12.02
AMINOGLYCOSIDES
AMIKACIN
Injection 250mg/mL
TOBRAMYCIN
Injection 10mg/mL, 40mg/mL
Powder 1.2g
08:12.04
ANTIFUNGALS
AMPHOTERICIN B
Injection 50mg
AMPHOTERICIN B LIPID COMPLEX INJECTION
Restricted Coverage: When used in sonsultation with an infectious disease specialist
under the following guidelines:
•
failure of Amphotericin B deoxycholate. For adults, this is normally defined as
poor clinical response to >500mg cumulative doses;
•
nephrotoxicity due to conventional Amphotericin B therapy as evidenced by
doubling of baseine serum creatinine or a significant rise from baseline plus
concomitant use of other potential nephrotoxins;
•
significant pre-existing renal failure – creatinine >220umol/L or CrCl
<25mL/minute or special renal condition (e.g. transplant or single kidney);
•
severe dose-related toxicities which do not resolve with premedication (e.g.
fever, rigors, hypotension).
FLUCONAZOLE
Restricted Coverage: Injection
Injection 2mg/mL
FLUCYTOSINE (HPB – Emergency Drug Release)
Injection 1g, 5g, 10g
Capsules 500mg
08:12.06
CEPHALOSPORINS
CEFAZOLIN
Injection 500mg, 1g
CEFOTAXIME
Restricted Coverage: Benefit status is automatic for first 72 hours in severe
infections. Long term use is covered when supported by sensitivity tests.
Injection 500mg, 1g, 2g
266
CEFOTETAN
Injection 1g, 2g
CEFOXITIN SODIUM
Injection 1g, 2g
CEFTAZIDIME
CEFTRIAXONE
CEFUROXIME (see Appendix A – Saskatchewan Health Formulary)
Tablet (axetil) 125mg
Injection 750mg, 1.5g
CEPHALOTHIN injection
08:12.07
MISCELLANEOUS BETA LACTAM ANTIBIOTICS
IMIPENEM/CILASTATIN
Restricted Coverage: For the treatment of severe infections on the recommendation
of an infectious disease specialist; internist or medical microbiologist.
Injection 250mg/250mg; 500mg/500mg
MEROPENEM
Restricted Coverage: For the treatment of severe infections on the
recommendation of an infectious disease specialist; internist or medical
microbiologist.
Injection
08:12.08
CHLORAMPHENICOL
CHLORAMPHENICOL
Injection 1g
08:12.12
ERYTHROMYCINS
AZITHROMYCIN (see Appendix A - Saskatchewan Health Formulary)
Injection
ERYTHROMYCIN
Injection (lactobionate) 500mg, 1g
08:12.16
PENICILLINS
AMPICILLIN
Injection 125mg, 250mg, 500mg, 1g, 2g
PIPERACILLIN
Injection 2g, 3g, 4g
PIPERACILLIN/TAZOBACTAM
Restricted Coverage: For the treatment of severe infections on the
recommendation of an infectious disease specialist; internist or medical
microbiologist.
Injection 2g/0.25g; 3g/0.375g; 4g/0.5g
TICARCILLIN
Injection 3g
267
08:12.28
MISCELLANEOUS ANTIBIOTICS
BACITRACIN STERILE
Vial 50,000 units
POLYMYXIN B SULFATE (injection only) (HPB – Special Access)
TM
QUINUPRISTIN/DALFOPRISTIN (Synercid )
Restricted Coverage: Reserved for use against multi-resistant gram positive
organisms, including Methicillin Resistant Staph. Aureus (MRSA) and vancomycin
resistant E.faecium, on the recommendation of an infectious disease specialist.
Injection
VANCOMYCIN
Injection
08:16.00
ANTITUBERCULOSIS AGENTS
ETHAMBUTOL
Tablet 100mg, 400mg
ISONIAZID
Tablet 50mg, 100mg, 300mg
Syrup 10mg/mL
PYRAZINAMIDE
Tablet 500mg
RIFAMPIN
Capsule 150mg, 300mg
08:18.00
ANTIVIRALS
ACYCLOVIR
Restricted Coverage:
a) IV form only when used for treatment of initial and recurrent mucosal and
cutaneous herpes simplex infections in immunocompromised patients and;
b) IV form when used for severe initial episodes of herpes simplex infections in
patients who may not be immunocompromised.
Suspension 40mg/mL
Injection 500mg, 1g
FOSCARNET (HPB – Special Access Program)
Injection 24mg/mL
GANCICLOVIR (see Appendix A - Saskatchewan Health Formulary)
Vial 500mg
RIBAVIRIN
Restricted Coverage: When used in a Pediatric Intensive Care Unit,
preferably on the basis of consultation with an infectious disease specialist, and
for proven or seriously ill cases during an outbreak of the Respiratory Syncytial
Virus (RSV).
Powder for inhalation solution 6g
08:22.00
QUINOLONES
CIPROFLOXACIN
Injection 10mg/mL
GATIFLOXACIN (see Appendix A - Saskatchewan Health Formulary)
Injection 10 mg/mL
LEVOFLOXACIN
268
08:40.00
MISCELLANEOUS ANTI INFECTIVES
LINEZOLID (see Appendix A - Saskatchewan Health Formulary)
Injection
PENTAMIDINE ISETHIONATE
Injection
Oral inhalation solution 300mg
10:00.00
ANTINEOPLASTIC AGENTS (Agents used for non-cancer indications.
See Formulary of the Saskatchewan Cancer Foundation for a complete listing of
antineoplastic agents.)
BLEOMYCIN
Injection 15 unit
CYCLOPHOSPHAMIDE
Tablet 25mg, 50mg
Injection 200mg, 1g
DAUNORUBICIN
Injection 20mg
DOXORUBICIN
Injection 2mg/mL
FLUOROURACIL
Injection 50mg/mL
METHOTREXATE
Injection 10mg/mL (2mL), 25mg/mL (2mL, 4mL, 8mL, 20mL, 40mL,
200mL)
Powder for injection 20mg
12:00.00
AUTONOMIC DRUGS
12:04.00
PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
EDROPHONIUM
Injection 10mg/mL
NEOSTIGMINE
Injection 0.5mg/mL (1:2000), 1mg/mL (1:1000)
Injection 2.5mg/mL (5mL)
12:08.00
ANTICHOLINERGIC AGENTS
12:08.08
ANTIMUSCARINIC/ANTISPASMODICS
- Also known as SCOPOLAMINE BUTYLBROMIDE
Injection 20mg/mL
HYOSCINE HYDROBROMIDE
- Also known as SCOPOLAMINE HYDROBROMIDE
Injection 0.4mg/mL, 0.6mg/mL
269
12:12.00
SYMPATHOMIMETIC (ADRENERGIC) AGENTS
DOBUTAMINE
Injection 12.5mg/mL
DOPAMINE
Injection 40mg/mL (20mL)
IV premixed bag 0.8mg/mL (250mL, 500mL) D5W
EPHEDRINE
Injection 50mg/1mL
Tablet 8mg, 15mg, 25mg, 30mg
Capsule 25mg
ISOPROTERENOL
Injection 0.2mg/mL (1:5000)
NOREPINEPHRINE
Injection 1mg/mL
PHENYLEPHRINE
Injection 10mg/mL
PSEUDOEPHEDRINE
Tablet 60mg
Syrup 6mg/mL
12:16.00
SYMPATHOLYTICS
PHENTOLAMINE MESYLATE
Injection
12:20.00
SKELETAL MUSCLE RELAXANTS
ATRACURIUM BESYLATE
Injection 10mg/mL (5mL, 10mL)
GALLAMINE TRIETHIODIDE
PANCURONIUM
Injection 2mg/mL
ROCURONIUM
SUCCINYLCHOLINE
Injection 20mg/mL
VECURONIUM
Injection 10mg
20:00.00
20:04.00
ANTIANEMIA DRUGS
20:04.04
IRON PREPARATIONS
FERROUS FUMARATE
Capsule
FERROUS GLUCONATE
Tablet
270
FERROUS SULPHATE
Tablet
Syrup
Oral drops
Oral solution
IRON DEXTRAN
Injection 50mg elemental iron/mL
20:12.00
COAGULANTS AND ANTICOAGULANTS
20:12.04
ANTICOAGULANTS
DALTEPARIN
see Appendix A - Saskatchewan Health Formulary.
for in-hospital treatment of acute coronary syndrome to a maximum of eight (8) days.
Injection
ENOXAPARIN
for in-hospital treatment of acute coronary syndrome to a maximum of eight (8)
days.
Injection
HEPARIN (not including low molecular weight formulations)
Injection 1,000 IU/mL (1mL, 10mL, 30mL)
Injection (subcutaneous) 25000 IU/mL (0.2mL, 2mL)
Injection (heparin lock flush) 100 IU/mL (2mL, 10mL)
IV premixed bags all strengths mixed in D5W and 0.9% NaCl
NADROPARIN
for in-hospital treatment of acute coronary syndrome to a maximum of eight (8)
days.
Injection
20:12.08
ANTIHEPARIN AGENTS
PROTAMINE SULPHATE
Injection 10mg/mL
20:12.16
HEMOSTATICS
AMINOCAPROIC ACID
Tablet 500mg
Injection 250mg/mL
ANTIHEMOPHILIC FACTOR VIII (HUMAN)
APROTININ
Injection 10,000 Kallikrein Inhibitory Units/mL
FACTOR IX
THROMBIN
Powder 5000 unit, 10000 unit vials
271
20:20.00
SKELETAL MUSCLE RELAXANT
ATRACURIUM BESYLATE
Ampoules 10mg
Injection 10mg/mL (single use 5mL vials)
Injection 10mg/mL (multi-use 10mL vials)
20:40.00
THROMBOLYTIC AGENTS
STREPTOKINASE
Injection 250,000 IU, 750000 IU, 1.5 million IU
TENECTEPLASE (TNK)
Restricted Coverage: For the treatment of patients with:
larger acute myocardial infarction and presenting within twelve (12) hours;
high risk inferior wall myocardial infarctions;
patients with significant hypotension or cardiogenic shock.
Injection
TISSUE PLASMINOGEN ACTIVATOR (tPA)
a) for the treatment of patients with:
larger acute myocardial infarction and presenting within twelve (12) hours.
high risk inferior wall myocardial infarctions.
patients with significant hypotension or cardiogenic shock.
Injection 50mg, 100mg
b) for the treatment of strokes when all the following circumstances are present:
within three (3) hours of the onset of symptoms;
under the guidance of a neurologist and a neuro-radiologist;
after a CT scan to rule out hemorrhage; and
in conjunction with established treatment protocols.
24:00.00
24.04.00
CARDIAC DRUG
ADENOSINE
Restricted Coverage: When used as an antiarrhythmic – for conversion to sinus
rhythm of paroxysmal supraventricular tachycardia, including those associated with
accessory bypass tracts (Wolf-Parkinson-White Syndrome).
Injection 3mg/mL
BRETYLIUM TOSYLATE
Injection 50mg/mL
DIGOXIN
Injection 0.05mg/mL (1mL), 0.25mg/mL (2mL)
DILTIAZEM
ESMOLOL
Restricted Coverage: For use in Operating Room or Critical Care Areas only for: the
perioperative management of tachycardia and hypertension in patients with atrial
fibrillation or atrial flutter in acute situations.
MILRINONE
a) When used in the short term management of ventricular dysfunction
272
unresponsive to digitalis, diuretics and vasodilators or as an aid to weaning off
an intra-aortic balloon pump when other inotropes have failed.
b) Must be administered in a critical care setting capable of invasive cardiac
monitoring including cardiac output, pulmonary capillary wedge
pressures and systemic vascular resistance.
PROCAINAMIDE
24:08.00
HYPOTENSIVE AGENTS
DIAZOXIDE
LABETALOL
Injection 5mg/mL
SODIUM NITROPRUSSIDE
Injection 50mg
24:12.00
VASODILATING AGENTS
NIMODIPINE
NITROGLYCERIN
PAPAVERINE
28:00.00
CENTRAL NERVOUS SYSTEM AGENTS
28:04.00
GENERAL ANESTHETICS
DESFLURANE
Inhalation solution 1mL/mL (240mL)
ENFLURANE
Solution 250mL
HALOTHANE
Solution 250mL
ISOFLURANE
Solution 100mL
KETAMINE
PROPOFOL
Injection 10mg/mL (20mL, 50mL, 100mL)
SEVOFLURANE
Solution 250mL
THIOPENTAL
Injection kit 1g, 2.5g
28:08.00
273
28:08.04
NON-STEROIDAL ANTI-INFLAMMATORY AGENTS
Tablet
Enteric coated tablet
Suppository
28:08.08
OPIATE AGONISTS
ALFENTANIL
FENTANYL
Injection 50ug/mL
METHADONE
Powder for oral solution
(Use of methadone is restricted to Health Protection Branch authorized
prescribers)
SUFENTANIL
Injection 50ug/mL
28:08.12
OPIATE PARTIAL AGONISTS
NALBUPHINE
Ampoule 10mg/mL
28:08.92
MISCELLANEOUS ANALGESICS AND ANTIPYRETICS
ACETAMINOPHEN
Tablet (chewable)
Tablet
Oral liquid
Elixir
Suppository
28:10.00
OPIATE ANTAGONISTS
NALOXONE
28:12.00
ANTICONVULSANTS
28:12.92
MISCELLANEOUS ANTICONVULSANTS
MAGNESIUM SULFATE
Injection 50mg/mL
28:16.00
PSYCHOTHERAPEUTIC AGENTS
28:16.08
TRANQUILIZERS
28:20.00
RESPIRATORY AND CEREBRAL STIMULANTS
274
DOXAPRAM (FDA – Special Access Program)
Restricted Coverage: When used for approved indications.
28:24.00
ANXIOLYTICS, SEDATIVES AND HYPNOTICS
28:24.04
BARBITURATES
28:24.08
BENZODIAZEPINES
MIDAZOLAM
Injection 1mg/mL (2mL, 5mL, 10mL), 5mg/mL (1mL, 2mL, 10mL)
28:24.92
MISCELLANEOUS ANXIOLYTICS, SEDATIVES AND HYPNOTICS
DROPERIDOL
Injection 2.5mg/mL
PARALDEHYDE
Injection 5mL ampoule (1mL is equivalent to approximately 1g)
36:00.00
DIAGNOSTIC AGENTS
36:56.00
MYASTHENIA GRAVIS
EDROPHONIUM
Injection 10mg/mL
40:00.00
ELECTROLYTIC, CALORIC AND WATER BALANCE
40:08.00
ALKALINIZING AGENTS
SODIUM BICARBONATE injectable preparations
Injection 0.5mEq/mL (4.2%), 1mEq/mL (8.4%) pre-load syringe
Injection 5g/100mL (5%) (500mL)
Injection 75mg/mL (7.5%)
Injection 1mEq/mL (8.4%)
TROMETHAMINE injection
Injection 36mg/mL (0.3 Molar)
40:12.00
ELECTROLYTE AND FLUID REPLACEMENT
CALCIUM CHLORIDE
Injection 10% - 100mg/mL (27mg elemental calcium/mL)
CALCIUM GLUCONATE
Injection 10% - 100mg/mL (9mg elemental calcium/mL)
CALCIUM ORAL DOSAGE FORMS
Note:
500mg elemental calcium = 12.5mmol or 25mEq elemental calcium
DEXTRAN 40
Solution 10% in D5W 500mL
Solution 10% in Saline 0.9% 500mL
275
DEXTRAN 70
Solution 6% in Saline 0.9% 500mL
MAGNESIUM ORAL DOSAGE FORMS
MAGNESIUM SULPHATE
Injection 50% - 500mg/mL (50mg elemental magnesium/mL)
Note:
5mg elemental magnesium = 0.2mmol or 0.4mEq elemental magnesium
PHOSPHATE
Injection potassium phosphate dibasic 236mg/mL
Injection potassium phosphate monobasic 224mg/mL
Effervescent tablet 500mg
POTASSIUM ACETATE
Injection 392mg/mL
POTASSIUM CHLORIDE
Injection 2mEq elemental potassium/mL
POTASSIUM PHOSPHATE
Vial 3mmol/mL
SODIUM CHLORIDE
Injection 2.5mEq/mL
Injection 4mEq/mL
SODIUM PHOSPHATE
Injection 3 mmol/mL
ZINC ORAL DOSAGE FORMS
40:20.00
CALORIC AGENTS
ABSOLUTE ALCOHOL INJECTION (dehydrated alcohol)
Injection 100% (10mL)
AMINO ACIDS SOLUTIONS (with or without electrolytes)
Includes all single substrate formulations
AMINO ACIDS / DEXTROSE SOLUTIONS (with or without electrolytes)
Includes all multisubstrate formulations
DEXTROSE
Injection 5%, 10%, 50%
FAT EMULSION PREPARATIONS
Injection 10%, 20%, 30%
40:28.00
DIURETICS
MANNITOL
44:00.00
ENZYMES
HYALURONIDASE
Injection 150 USP units/mL
48:00.00
ANTITUSSIVES, EXPECTORANTS AND MUCOLYTIC AGENTS
276
48:08.00
ANTITUSSIVES
DEXTROMETHORPHAN
Syrup 3mg/mL
48:16.00
EXPECTORANTS
GUAIFENESIN
Oral solution 20mg/mL
48:24.00
MUCOLYTIC AGENTS
ACETYLCYSTEINE INJECTION
Antidote for acetaminophen poisoning
20% solution
52:00.00
EYE, EAR, NOSE AND THROAT PREPARATIONS
52:04.00
ANTI-INFECTIVES
52:04.04
ANTIBIOTICS
POLYMYXIN B/GRAMICIDIN or BACITRACIN
Ophthalmic/otic solution, each mL: 10,000 units/0.25mg (gramicidin)
Ophthalmic ointment, each g: 10,000 units/500 units (bacitacin)
52:16.00
LOCAL ANESTHETICS
BENZOCAINE
Gel, topical 7.5%
Spray, 20%
Gel, topical 20%
COCAINE
Topical solution 100mg/mL: 4% (4mL), 10% (5mL)
LIDOCAINE (except for lozenges and suppositories)
Aerosol, endotracheal
Liquid (viscous), topical 2%
PROPARACAINE
Ophthalmic solution 0.5%
TETRACAINE
Ophthalmic solution minums 0.5%
Aerosol 754 mg / 65g (oral)
52:20.00
MIOTICS
ACETYLCHOLINE
Solution, intraocular irrigation 10mg/mL
52:24.00
MYDRIATICS
277
PHENYLEPHRINE
Ophthalmic solution minums 10%
TROPICAMIDE
Ophthalmic solution 0.5%, 1%
52:32.00
VASOCONSTRICTORS
NAPHAZOLINE
XYLOMETAZOLINE
Nasal spray 0.05%, 0.1%
Nasal solution 0.05%, 0.1%
52:36.00
MISCELLANEOUS EYE, EAR, NOSE AND THROAT DRUGS
ALUMINUM ACETATE
Solution, otic 0.5%
ARTIFICIAL TEARS
Ophthalmic solution
FLUORESCEIN SODIUM
Ophthalmic solution 2%, 10%
Strip, ophthalmic 1mg
56:00.00
GASTROINTESTINAL DRUGS
56:04.00
ANTACIDS AND ADSORBENTS
ACTIVATED CHARCOAL
Suspension (aqueous), oral - 200mg/mL
Suspension (in sorbitol), oral - 200mg/mL
56:08.00
ANTIDIARRHEA AGENTS
ATTAPULGITE
Tablet 300mg, 600mg, 750mg
Suspension 40mg/mL, 50mg/mL
56:12.00
CATHARTICS AND LAXATIVES
CASTOR OIL
FLEET
Enema with monobasic sodium phosphate 16g/100mL, dibasic sodium
phosphate 6g/100mL
Enema with monobasic sodium phosphate 16g/100mL, dibasic sodium
phosphate 6g/100mL, & mineral oil
FLEET PHOSPHO - SODA BUFFERED SALINE
Oral solution with sodium biphosphate 900mg/5mL, sodium phosphate
monobasic 2.4g/5mL
GLYCERIN
Suppository - infant 1.63g, adult 2.67g
278
SENNOSIDES (Standardized)
Liquid 119mg/70mL
Powder 157.5mg/21g pouch
Tablet 8.6mg, 12mg, 15mg, 25mg
Granules 15mg/3g=1tsp
Syrup 1.7mg/mL (70mL, 100mL, 250mL, 500mL)
Suppository 30mg
56:20.00
EMETICS
IPECAC
Syrup
56:22.00
ANTIEMETICS
DROPERIDOL
Injection 2.5mg/mL
56:40.00
MISCELLANEOUS GASTROINTESTINAL DRUGS
PANTOPRAZOLE IV
when ordered in a high dose (80mg IV bolus followed by 8mg/hour x 72 hours)
by a gastroenterologist or general surgeon following endoscopic hemostasis
for non-variceal upper gastrointestinal bleeding; or
when ordered as Pantoprazole 40mg IV q24h for patients who are strict NPO
(i.e. not taking any oral medications or oral diet) and have:
non-variceal upper GI bleeding not requiring endoscopic hemostatis; or
severe erosive esophagitis; or
Exception Drug Status (EDS) for a Proton Pump Inhibitor taken prior to
admission.
Injection
64:00.00
HEAVY METAL ANTAGONISTS
CALCIUM DISODIUM EDETATE
Restricted Coverage: Used in the treatment of lead poisonings and other select
heavy metal poisonings (zinc, manganese, nickel, chromium and certain
radioisotopes). (Coverage not provided for chelation therapy.)
Injection 200mg/mL
Injection 500mg, 2g vial
DIMERCAPROL
Injection 100mg/mL
68:00.00
HORMONES AND SYNTHETIC SUBSTITUTES
68:04.00
ADRENALS
METHYLPREDNISOLONE
Plain
Injection 40mg, 50mg, 125mg, 500mg, 1g
Injection (depot) 20mg/mL, 40mg/mL, 80mg/mL (5mL)
With Lidocaine
279
Injection 10mg/mL, 40mg/mL (1mL, 2mL, 5mL)
68:08.00
ANDROGENS
FLUOXYMESTERONE
Tablet 5mg
68:28.00
PITUITARY
ACTH (adrenocorticotropic hormone / corticotropin)
Jelly 80 unit/mL (5mL)
Powder 80 unit
VASOPRESSIN
Injection (aqueous) 20 units/mL
68:36.00 THYROID AND ANTITHYROID AGENTS
POTASSIUM IODIDE
Tablet 130mg
72:00.00
LOCAL ANESTHETICS
ARTICAINE
Cartridge 4% (5ug/mL epinephrine) (1.7mL)
BUPIVACAINE
Injection 0.25%, 0.5%, 0.75%
Injection 0.25% with epinephrine 1:200,000
Injection, spinal 0.75% with dextrose 8.25% (2mL)
CHLOROPROCAINE
Injection, caudal-epidural 2%, 3%
LIDOCAINE (with the exception of lozenges or suppositories)
Injection 0.5%, 1%, 2%
Injection 1% with epinephrine 1:100,000
Injection, epidural 1.5%, 2%
Injection, epidural 1.5% with epinephrine 1:200,000
Injection, epidural 2% with carbon dioxide
Injection, spinal 5% with glucose 7.5% - 2mL vial
MEPIVACAINE
Injection 1%
Injection, caudal-epidural 1%, 2%
PRILOCAINE
Solution 4%
PROCAINE
Vial 2%
TETRACAINE
Injection 20mg ampoule
72:00.00
OXYTOCICS
280
ALPROSTADIL
Injection 0.5mg/mL
CARBOPROST
Injection 250mg/mL
DINOPROSTONE
Tablet 0.5mg
Gel 0.5mg/2.5mL, 1mg/2.5mL, 2mg/2.5mL syringe
Vaginal insert 10mg
DINOPROST TROMETHAMINE
Injection 5mg/mL
ERGOMETRINE MALEATE
Injection 0.25mg/mL
OXYTOCIN
Injection 10 units/mL
80:00.00
SERUMS, TOXOIDS AND VACCINES
Note:
* indicates the product is supplied to health regions by Saskatchewan Health
**indicates the product is supplied to health regions by the Canadian Blood Services
80:04.00
SERUMS
DIGOXIN IMMUNE FAB
a) When used for the treatment of severe, life threatening digoxin toxicity as
defined by: (1) severe ventricular tachy or bradyarrhythmias and/or (2)
progressive hyperkalemia of greater then 5mmol/L in the setting of severe
digoxin toxicity.
b) It is recommended one of the following medical specialties be consulted before
this agent is administered: cardiologist; internist; or pediatrician.
Injection 38mg
DIPHTHERIA ANTITOXIN*
Injection 20,000 IU vial
HEPATITIS B IMMUNE GLOBULIN (HUMAN)**
IMMUNE GLOBULIN (HUMAN IV)**
Injection 0.5%, 10% solution
IMMUNE SERUM GLOBULIN (HUMAN IM)
Injection 18%
TETANUS IMMUNE GLOBULIN (HUMAN)
Injection 250 unit
80:08.00
TOXOIDS
DIPHTHERIA TOXOID*
50Lf/mL (1mL, 10mL)
DIPHTHERIA TETANUS TOXOIDS*
Injection (2Lf / 0.5mL diphtheria toxoid and 5Lf/0.5mL tetanus toxoid)
(5mL – adult adsorbed)
Injection (25Lf/0.5mL diphtheria toxoid and 5Lf/0.5mL tetanus toxoid) (0.5mL,
5mL)
DIPHTHERIA TOXOID/PERTUSSIS VACCINE/TETANUS TOXOID (DPT
Adsorbed)*
281
Injection (diphtheria toxoid 25Lf/0.5mL, tetanus toxoid 5Lf/0.5mL, pertussis
vaccine 4 to 12 PU/0.5mL)
TETANUS DIPHTHERIA TOXOIDS/POLIOMYELITIS VACCINE*
Injection (diphtheria toxoid 2Lf/0.5mL, poliamyelitis vaccine (inactivated)
NIL/0.5mL, tetanus toxoid
5Lf/0.5mL)
DIPHTHERIA TOXOID/PERTUSSIS/TETANUS/POLIOVIRUS VACCINE/
HAEMOPHILUS INFLUENZA TYPE B (PENTA VACCINE)
80:12.00
VACCINES
HEPATITIS B IMMUNE GLOBULIN**
Injection 217 IU/mL
HEPATITIS B VACCINE*
Injection 20ug/mL
INFLUENZA VIRUS VACCINE*
Injection 5mL
MEASLES/MUMPS/RUBELLA VACCINE*
Injection NIL/0.5mL
PNEUMOCOCCAL VACCINE*
Injection 50ug/0.5mL
POLIOMYELITIIS VACCINE*
Injection 0.5mL
RUBELLA VIRUS VACCINE*
Injection 31000 TCID50/0.5mL
BCG VACCINE*
Injection 0.1mg/0.1mL
HAEMOPHILUS INFLUENZAE TYPE B VACCINE*
84:00.00
SKIN AND MUCOUS MEMBRANE AGENTS
84:04.00
ANTI INFECTIVES
84:04.04
ANTIBIOTICS
BACITRACIN
Ointment 500 IU/g
84:04.08
ANTIFUNGALS
TOLNAFTATE
Aerosol liquid 0.72mg/g (70g)
Aerosol powder 10mg/g
Cream 10mg/g
Powder 10mg/g
Solution 10mg/mL
84:04.16
MISCELLANEOUS LOCAL ANTI-INFECTIVES
CHLORHEXIDINE
Alcoholic scrub
Cleanser 4%
282
Gauze 0.5%
Jelly 2%, 4%
Liquid 2%, 4%, 20%
Ointment 1%
Soap 2%
MAFENIDE
Cream 8.5%
SILVER SULFADIAZINE
Cream 1% w/w
84:08.00
ANTI PRURITICS AND LOCAL ANESTHETICS
CALCIUM FOLINATE (folinic acid)
Powder 50mg, 350mg
Tablets 5mg
Injection 10mg/mL
DIBUCAINE
Cream 0.5% (30g)
Ointment 1% (30g)
LIDOCAINE/PRILOCAINE
Topical cream 2.5%/2.5%
Patch
LIDOCAINE (except lozenges and suppositories)
Jelly 2%
Jelly (urojet) 2%
Ointment 5%
Topical solution 4%
PRAMOXINE
Cream, rectal 1%
84:24.00
EMOLLIENTS, DEMULCENTS AND PROTECTANTS
84:24.12
BASIC CREAMS, OINTMENTS AND PROTECTANTS
ZINC OXIDE
Ointment 15%
84:24.16
BASIC POWDERS AND DEMULCENTS
GELATIN, PECTIN, SODIUM CARBOXYMETHYLCELLULOSE
Paste 13.3% gelatin, 13.3% pectin, 13.3% sodium carboxymethylcellulose
84:40:00
HEMORRHOID PREPARATIONS
PRAMOXINE
Ointment, rectal 1%, with zinc sulphate 0.5%
Suppository 20MG, with zinc sulphate 10mg
88:00.00
VITAMINS
88:16.00
VITAMIN D
ALFACALCIDOL DISODIUM INJECTION
283
CALCITRIOL
also known as 1,25-DIHYDROXYCHOLECALCIFEROL
Injection 1ug/mL
DIHYDROTACHYSTEROL
Capsule 0.125mg
92:00.00
-
ABCIXMAB INJECTION
Restricted Coverage: For use in high risk angioplasties carried out in a cardiac
catheterization laboratory as per approved health region protocols.
Injection 2 mg/mL (5mL)
ACTHAR GEL 80IU/5mL (Emergency Drug Release from HPB for infantile spasms)
BASILIXIMAB
Restricted Coverage: For prophylaxis of acute rejection in renal transplant patients.
Injection
BERACTANT
Restricted Coverage: When administered in a Neonatal Intensive Care Unit.
Powder (reconstituted) 25mg phospholipids/mL
CLIMACTERON
Restricted Coverage: When used in hospital for post-hysterectomy patients.
Injection
COLFOSCERIL PALMITATE
Restricted Coverage: When administered in a Neonatal Intensive Care Unit.
Powder for tracheal suspension
CYANIDE ANTIDOTE KIT
With sodium nitrate injection 30mg/mL (2 x 10mL ampoules), sodium thiosulfate
injection 250mg/mL (2 x 50mL ampoules), amyl nitrate inhalant solution (12 x
0.3mL crushable ampoules)
CYCLOSPORINE (see Appendix A - Saskatchewan Health Formulary)
Injection 50mg/mL
DACLIZUMAB
Restricted Coverage: For prophylaxis of acute rejection in renal transplant patients.
Injection
DIMETHYL SULFOXIDE
Solution 500mg/g (50mL)
EPTIFIBITIDE
Restricted Coverage: When used on the recommendation of a cardiologist for
the treatment of High Risk Unstable Angina and Non-ST Segment Elevation
Myocardial Infarction according to the guidelines of The American College of
Cardiology & American Heart Association, Inc. (Circulation, 2000; 102: 11931209)
Injection
ETANERCEPT (see Appendix A - Saskatchewan Health Formulary)
Injection
LEVOCARNITINE
Restricted Coverage: For the treatment of metabolic disorders with carnitine
deficiency and neonates who will be on long term Total Parenteral Nutrition (greater
than 14 days).
Injection 200mg/mL
Oral solution 100mg/mL
Tablet 330mg
284
OCTREOTIDE
a) For the treatment of acute variceal bleeds in patients with acute portal
hypertension.
b) For the prevention of fistulas following pancreatic resection to a maximum of 7
days.
Injection 50ug, 100ug, 500ug (1mL)
Injection 200ug (5mL)
Injection 10mg, 20mg, 30mg (powder for injection)
PRALIDOXIME CHLORIDE
Injection, 1g vial
SOMATOSTATIN
Restricted Coverage: For the treatment of acute variceal bleeds.
Powder 205ug, 3mg
TIROFIBAN
Restricted Coverage: When used on the recommendation of a cardiologist for
the treatment of High Risk Unstable Angina and Non-ST Segment Elevation
Myocardial Infarction according to the guidelines of The American College of
Cardiology & American Heart Association, Inc. (Circulation, 2000; 102: 11931209)
Injection
TRACE ELEMENTS
Chromium 4ug/mL
Copper 0.4mg/mL
Manganese 0.1mg/mL, 0.5mg/mL
Selenium 40ug/mL
Zinc 1mg/mL, 5mg/mL
Note: May come as cocktails.
(M.T.E.-4 contains: 4.0ug/mL chromium, 0.4mg/mL copper, 0.1mg/mL
manganese, and 1.0mg/mL zinc)
(Micro 5 contains: 10ug/mL chromium, 1mg/mL copper, 0.5mg/mL manganese,
60ug/mL selenium, 5mg/mL zinc)
285
APPENDIX I: Products included in the Hospital Benefit List, and as referred to in 3
(a), (b), and (c) are approved for use and are benefits only when manufactured by
approved suppliers as listed in the Saskatchewan Formulary or included below:
Adria
Anaquest
Cutter
IMS
Johnson & Johnson-Merck
Lyphomed
Mallinkrodt
Metapharma
Smith & Nephew
APPENDIX II: PROCEDURES FOR OBTAINING DRUGS PROVIDED UNDER
PROVINCIAL PROGRAMS
Drugs Used for the Treatment of Tuberculosis:
The following drugs can be obtained for use in the treatment of tuberculosis by contacting
the Clinical Director for Tuberculosis Control (933-6166). The drugs will be sent from the
TB Pharmacy in Ellis Hall at the Royal University Hospital in Saskatoon.
Amikacin injection 500mg/2mL
Cycloserine capsules 250mg
Ethambutol tablets, 100mg, 400mg
Ethionamide tablets 250mg
Isoniazide syrup 10mg/mL, tablets 100mg, 300mg
Pyrazinamide tablet 500mg
Rifabutin capsule 150mg
Rifampin capsule 150mg, 300mg, suspension 25mg/mL
Drugs Used for the Treatment of Sexually Transmitted Diseases:
•
The following drugs can be obtained from Saskatchewan Health – Communicable
Disease Control at (306) 787-7104 for the treatment of sexually transmitted
diseases:
Azithromycin 1g
Erythromycin PCE 333mg or 250mg
Cefixime 400mg
•
The following medication/vaccines are available on special request from
Saskatchewan Health – Communicable Disease Control (306) 787-1460:
Benzathine Penicillin 1.2 MU IM injection
Ciprofloxacin 500mg
286
INDEX
ANTITUSSIVES .............................. 277
ANTIVIRALS ................................... 268
ANUSOL.......................................... 283
ANXIOLYTICS, SEDATIVES AND
HYPNOTICS ............................... 275
ASA ................................................. 274
ATTAPULGITE................................ 278
AZITHROMYCIN ............................. 267
BACIGUENT ................................... 282
BACITRACIN................................... 282
BACITRACIN STERILE................... 268
BAL IN OIL ...................................... 279
BARBITURATES............................. 275
BASILIXIMAB .................................. 284
BENADRYL ..................................... 266
BENYLIN DM .................................. 277
BENZOCAINE ................................. 277
BENZODIAZEPINES....................... 275
BERACTANT................................... 284
BETA LACTAM ANTIBIOTICS ........ 267
BLENOXANE .................................. 269
BLEOMYCIN ................................... 269
BRETYLIUM.................................... 272
BREVIBLOC.................................... 272
BUPIVACAINE ................................ 280
BURO SOL...................................... 278
CALCITRIOL ................................... 284
CALCIUM CHLORIDE..................... 275
CALCIUM DISODIUM EDETATE.... 279
CALCIUM GLUCONATE ................. 275
CALORIC AGENTS......................... 276
CARBOCAINE................................. 280
CARDIZEM...................................... 272
CARNITOR...................................... 284
CATHARTICS AND LAXATIVES .... 278
CEFAZOLIN .................................... 266
CEFOTAXIME ................................. 266
CEFOTETAN................................... 267
CEFOXITIN ..................................... 267
CEFTAZIDIME ................................ 267
CEFTIN ........................................... 267
CEFTRIAXONE............................... 267
CEFUROXIME ................................ 267
CEPHALOSPORINS ....................... 266
CHLORAMPHENICOL .................... 267
CHLORHEXIDINE ........................... 282
CHLOROMYCETIN......................... 267
CHLOROPROCAINE ...................... 280
CHOLINERGIC AGENTS................ 269
CIPRO ............................................. 268
CIPROFLOXACIN ........................... 268
CLAFORAN..................................... 266
CLIMACTERON .............................. 284
COCAINE ........................................ 277
1,25DIHYDROXYCHOLECALCIFEROL
.................................................... 284
ACEBUTOLOL ................................ 272
ACETAMINOPHEN ......................... 274
ACETYLCHOLINE .......................... 277
ACETYLSALICYLIC ACID .............. 274
ACTIVASE ...................................... 272
ACTIVATED CHARCOAL ............... 278
ACYCLOVIR ................................... 268
ADENOCARD ................................. 272
ADENOSINE ................................... 272
ADRENALS..................................... 279
ADRIAMYCIN.................................. 269
ALCAINE......................................... 277
ALCOHOL (ETHYL) DRESSING .... 282
ALFACALCIDOL DISODIUM
INJECTION ................................. 283
ALFENTA ........................................ 274
ALFENTANIL .................................. 274
ALKALINIZING AGENTS ................ 275
ALPROSTADIL ............................... 281
ALUMINUM ACETATE.................... 278
AMICAR .......................................... 271
AMIKACIN....................................... 266
AMIKIN............................................ 266
AMINOCAPROIC ACID................... 271
AMINOGLYCOSIDES ..................... 266
AMPHOTERICIN B ......................... 266
AMPHOTERICIN B LIPID COMPLEX
INJECTION ................................. 266
AMPICILLIN .................................... 267
.................................................... 273
ANCEF ............................................ 266
ANDROGENS ................................. 280
ANECTINE ...................................... 270
ANTACIDS AND ADSORBENTS ... 278
ANTIANEMIA DRUGS .................... 270
ANTICHOLINERGIC AGENTS ....... 269
ANTICOAGULANTS ....................... 271
ANTICONVULSANTS ..................... 274
ANTIDIARRHEA AGENTS.............. 278
ANTIEMETICS ................................ 279
ANTIFUNGALS ............................... 266
ANTIHEMOPHILIC FACTOR VIII.... 271
ANTIHEPARIN AGENTS ................ 271
ANTIHISTAMINE DRUGS............... 266
ANTIMUSCARINIC/ANTISPASMODIC
S.................................................. 269
ANTINEOPLASTIC AGENTS.......... 269
ANTIPRURITICS AND LOCAL
ANESTHETICS ........................... 283
ANTITUBERCULOSIS AGENTS .... 268
287
COLFOSCERIL PALMITATE .......... 284
CYANIDE ANTIDOTE KIT............... 284
CYCLOPHOSPHAMIDE ................. 269
CYCLOSPORINE............................ 284
CYPROHEPTADINE ....................... 266
CYTOXAN....................................... 269
DACLIZUMAB ................................. 284
DALTEPARIN.................................. 271
DEFEROXAMINE............................ 279
DEPO MEDROL.............................. 280
DESFERAL ..................................... 279
DEXTRAN 40 .................................. 275
DEXTRAN 70 .................................. 276
DEXTROMETHORPHAN................ 277
DEXTROSE .................................... 276
DIAGNOSTIC AGENTS .................. 275
DIAZOXIDE..................................... 273
DIFLUCAN ...................................... 266
DIGIBIND ........................................ 281
DIGOXIN ......................................... 272
DIGOXIN IMMUNE FAB.................. 281
DILTIAZEM ..................................... 272
DIMERCAPROL .............................. 279
DINOPROSTONE ........................... 281
DIPHENHYDRAMINE ..................... 266
DIPHTHERIA ANTITOXIN .............. 281
DIPHTHERIA TETANUS TOXOIDS 281
DIURETICS..................................... 276
DOBUTAMINE ................................ 270
DOBUTREX .................................... 270
DOPAMINE ..................................... 270
DOPRAM ........................................ 275
DOXAPRAM.................................... 275
DOXORUBICIN ............................... 269
DROPERIDOL ........................ 275, 279
DT ADSORBED .............................. 281
DURAGESIC................................... 274
EDROPHONIUM ..................... 269, 275
EFUDEX.......................................... 269
ELECTROLYTE AND FLUID
REPLACEMENT ......................... 275
EMETICS ........................................ 279
ENLON............................................ 275
ENOXAPARIN................................. 271
ENTROPHEN.................................. 274
ENZYMES....................................... 276
EPTIFIBITIDE ................................. 284
ERGOMETRINE MALEATE............ 281
ERGONOVINE................................ 281
ERYTHROMYCIN ........................... 267
ESMOLOL HYDROCHLORIDE ...... 272
ETANERCEPT ................................ 284
ETHAMBUTOL................................ 268
EXOSURF....................................... 284
EXPECTORANTS ........................... 277
EYE, EAR, NOSE AND THROAT
PREPARATIONS ........................ 277
FACTOR IX COMPLEX................... 271
FENTANYL...................................... 274
FERGON ......................................... 270
FERROUS GLUCONATE................ 270
FERROUS SULPHATE ................... 271
FLAMAZINE .................................... 283
FLAMAZINE-C ................................ 283
FLEET ............................................. 278
FLEET PHOSPHO SODA BUFFERED
SALINE........................................ 278
FLUCONAZOLE.............................. 266
FLUOR I STRIP............................... 278
FLUORESCEIN SODIUM................ 278
FLUORESCITE ............................... 278
FLUOROURACIL ............................ 269
FLUOXYMESTERONE ................... 280
FORTAZ .......................................... 267
FUNGIZONE ................................... 266
GATIFLOXACIN ............................. 268
GENERAL ANESTHETICS ............. 273
GLYCERIN ...................................... 278
GUAIFENESIN ................................ 277
HALOTESTIN.................................. 280
HEAVY METAL ANTAGONISTS..... 279
HEMORRHOID PREPARATIONS .. 283
HEMOSTATICS .............................. 271
HEPARIN ........................................ 271
HEPATITIS B IMMUNE GLOBULIN 281
HEPATITIS B VACCINE.................. 282
HIBITANE........................................ 282
HORMONES AND SYNTHETIC
SUBSTITUTES............................ 279
HYALURONIDASE.......................... 276
HYDROCONTIN.............................. 274
HYOSCINE BUTYLBROMIDE ........ 269
HYOSCINE HYDROBROMIDE ....... 269
HYPERSTAT................................... 273
HYPOTENSIVE AGENTS ............... 273
HYSKON ......................................... 276
IMIPENEM CILASTATIN ................. 267
IMMUNE GLOBULIN....................... 281
IMMUNE SERUM GLOBULIN......... 281
INAPSINE................................ 275, 279
INFLUENZA VIRUS VACCINE........ 282
INH .................................................. 268
INTROPIN ....................................... 270
IPECAC ........................................... 279
IRON PREPARATIONS .................. 270
ISOFLURANE ................................. 273
ISONIAZID ...................................... 268
ISOPROTERENOL ......................... 270
ISUPREL ......................................... 270
KAOPECTATE ................................ 278
KEFZOL .......................................... 266
288
LABETALOL.................................... 273
LANOXIN ........................................ 272
LEVARTERENOL............................ 270
LEVOCARNITINE ........................... 284
LEVOPHED..................................... 270
LIDOCAINE......................277, 280, 283
LINEZOLID ..................................... 269
LOCAL ANESTHETICS .......... 277, 280
M M R II........................................... 282
MAFENIDE...................................... 283
MAGNESIUM SULPHATE .............. 276
MANNITOL...................................... 276
MARCAINE ..................................... 280
MCT OIL.......................................... 276
MEASLES/MUMPS/RUBELLA
VACCINE .................................... 282
MEDIUM CHAIN TRIGLYCERIDES OIL
.................................................... 276
MEFOXIN........................................ 267
MEPIVACAINE................................ 280
MEROPENEM................................. 267
METHADONE ................................. 274
METHOHEXITAL ............................ 275
METHOTREXATE........................... 269
METHYLPREDNISOLONE ACETATE
.................................................... 279
MIDAZOLAM................................... 275
MIOCHOL ....................................... 277
MIOTICS ......................................... 277
MISCELLANEOUS
GASTROINTESTINAL DRUGS... 279
MYAMBUTOL ................................. 268
MYDFRIN........................................ 278
MYDRIACYL ................................... 278
MYDRIATICS .................................. 277
NADROPARIN ................................ 271
NALBUPHINE ................................. 274
NALOXONE .................................... 274
NAPHAZOLINE ............................... 278
NARCAN ......................................... 274
NEO SYNEPHRINE ........................ 270
NEOSTIGMINE ............................... 269
NESACAINE CE ............................. 280
NIPRIDE.......................................... 273
NITROGLYCERIN........................... 273
NITROPRUSSIDE........................... 273
NON STEROIDAL ANTI
INFLAMMATORY AGENTS ........ 274
NORCURON ................................... 270
NOREPINEPHRINE ........................ 270
NOVOCAINE................................... 280
NUBAIN........................................... 274
OPIATE AGONISTS........................ 274
OPIATE ANTAGONISTS ................ 274
OPIATE PARTIAL AGONISTS........ 274
ORAJEL .......................................... 277
OTRIVIN.......................................... 278
OXYTOCICS ................................... 280
OXYTOCIN...................................... 281
PANCURONIUM ............................. 270
PANTOPRAZOLE IV ...................... 279
PAPAVERINE ................................. 273
PARALDEHYDE.............................. 275
PAVULON ....................................... 270
PENBRITIN ..................................... 267
PENICILLINS .................................. 267
PENTACARINAT............................. 269
PENTAMIDINE ISETHIONATE ....... 269
PERIACTIN ..................................... 266
PHENERGAN.................................. 266
PHENTOLAMINE ............................ 270
PHENYLEPHRINE .................. 270, 278
PHOSPHATE .................................. 276
PHOSPHATE SANDOZ .................. 276
PIPERACILLIN ................................ 267
PIPRACIL ........................................ 267
PITRESSIN ..................................... 280
PITUITARY...................................... 280
PNEUMOCOCCAL VACCINE......... 282
PNEUMOVAX 23 ............................ 282
POLYSPORIN ................................. 277
PONTOCAINE......................... 277, 280
POTASSIUM ACETATE.................. 276
POTASSIUM CHLORIDE................ 276
POTASSIUM PHOSPHATE ............ 276
PRALIDOXIME CHLORIDE ............ 285
PRAMOXINE................................... 283
PRIMAXIN ....................................... 267
PROCAINAMIDE............................. 273
PROCAINE...................................... 280
PROMETHAZINE............................ 266
PRONESTYL................................... 273
PROPARACAINE............................ 277
PROSTIN E2 ................................... 281
PROSTIN VR .................................. 281
PROTAMINE SULPHATE ............... 271
PROTOPAM.................................... 285
PSEUDOEPHEDRINE .................... 270
QUINOLONES ................................ 268
QUINUPRISTIN/DALFOPRISTIN
TM
(Synercid )................................. 268
RESPIRATORY AND CEREBRAL
STIMULANTS ............................. 274
RHEOMACRODEX ......................... 275
RIBAVIRIN ...................................... 268
RIFADIN .......................................... 268
RIFAMPIN ....................................... 268
RIMSO............................................. 283
ROCALTROL .................................. 284
ROCEPHIN ..................................... 267
ROGITINE ....................................... 270
SCOPOLAMINE BUTYLBROMIDE. 269
289
THROMBOSTAT............................. 271
TICAR.............................................. 267
TICARCILLIN .................................. 267
TIROFIBAN ..................................... 285
TISSUE PLASMINOGEN ACTIVATOR
(tPA) ............................................ 272
TOBRAMYCIN ................................ 266
TOXOIDS ........................................ 281
TRANQUILIZERS............................ 274
TRASYLOL...................................... 271
TRIMETHOPRIM............................. 269
TROMETHAMINE ........................... 275
TRONOTHANE ............................... 283
TROPICAMIDE ............................... 278
TYLENOL ........................................ 274
VACCINES ...................................... 282
VASOCON ...................................... 278
VASOCONSTRICTORS.................. 278
VASODILATING AGENTS .............. 273
VASOPRESSIN............................... 280
VECURONIUM................................ 270
VERSED.......................................... 275
VIRAZOLE....................................... 268
VITAMIN D ...................................... 283
WYDASE......................................... 276
X PREP ........................................... 279
XYLOCAINE.................................... 280
XYLOMETAZOLINE ........................ 278
ZINACEF ......................................... 267
ZINC OXIDE.................................... 283
ZINCOFAX ...................................... 283
ZOVIRAX......................................... 268
SCOPOLAMINE HYDROBROMIDE 269
SENSORCAINE .............................. 280
SERUMS......................................... 281
SILVER SULFADIAZINE................. 283
SKELETAL MUSCLE RELAXANTS 270
SKIN AND MUCOUS MEMBRANE
AGENTS ..................................... 282
SLOW-K .......................................... 276
SODAMINT ..................................... 275
SODIUM BICARBONATE ............... 275
SODIUM CHLORIDE ...................... 276
SODIUM PHOSPHATE................... 276
STREPTOKINASE .......................... 272
SUBLIMAZE.................................... 274
SUCCINYLCHOLINE ...................... 270
SUDAFED ....................................... 270
SUFENTA ....................................... 274
SUFENTANIL.................................. 274
SULFAMYLON ................................ 283
SURVANTA..................................... 284
SYMPATHOLYTICS........................ 270
SYNTOCINON ................................ 281
TAZOCIN ........................................ 267
TENECTEPLASE (TNK)................. 272
TENSILON .............................. 269, 275
TETANUS DIPHTHERIA
TOXOIDS/POLIOMYELITIS
VACCINE .................................... 282
TETANUS IMMUNE GLOBULIN ..... 281
TETRACAINE ......................... 277, 280
THROMBIN TOPICAL..................... 271
THROMBOLYTIC AGENTS ............ 272
290
APPENDIX C
TIPS ON PRESCRIPTION WRITING
(Adapted from "Tips on Prescription Writing", a pamphlet available from the
Saskatchewan Pharmaceutical Association.)
Properly issued prescriptions are in the best interest of the patient, the pharmacist and
the prescriber. This information is designed to assist prescribers to issue prescriptions
most effectively. These guidelines will help to reduce the time involved in the prescription
process, increase patient safety and maximize patient compliance.
PRESCRIPTION CONTENT
Prescriptions need to be issued clearly and completely to minimize errors.
pronunciation or legible writing with accurate spelling is essential.
Clear
The prescription may be written, or verbal for certain classes of drugs, (refer to chart on
pages 270 and 271) and must include the following information:
date
physician's name and signature
patient's name
full name of the medication
medication concentration where appropriate
medication strength where appropriate
dosage
amount prescribed or the duration of treatment
administration route if other than oral
explicit instructions for patient usage of the medication
number of refills where refills are authorized
The prescriber's name, address and telephone number should be preprinted on the
prescription form, or hand printed beneath the signature.
VERBAL PRESCRIPTIONS
Federal and Provincial legislation states that a verbal prescription or refill authority must
be given by a medical practitioner, duly qualified optometrist, dentist or veterinary
surgeon directly to a pharmacist. Having a receptionist or nurse assume this
responsibility is contrary to the law.
Direct prescriber/pharmacist communication is necessary to provide the best quality of
care for the patient. The pharmacist may wish to discuss an aspect of the drug therapy
prior to dispensing the medication. As well, the prescriber may wish to ask the
pharmacist about a particular medication, or a patient's medication history, compliance,
or pattern of drug use. Both the professionals and the patient will benefit from this direct
communication.
MEDICATION DIRECTIONS
Pharmacists maintain patient profiles which contain information concerning prescriptions
dispensed, directions for use, drug allergies, medical conditions, and other pertinent
information. These profiles are used to monitor the patient's drug usage and compliance,
and drug interactions. Thus, it is very important that directions on the prescription be
consistent with verbal instructions given to the patient. Clear directions enable the
pharmacist to effectively counsel the patient and reinforce the prescriber's instructions.
292
Prescriptions with closing instructions written "As Directed" create problems for the
patient, particularly the elderly or those assisting them. Patients taking more than one
medication may become confused if all instructions read "As Directed". Such labelling
also makes it impossible for pharmacists to monitor compliance, or assist patients with
medication concerns.
It is helpful for a patient taking more than one medication, or for the caregiver, to know
what the medication is used for. The prescriber may wish to indicate the use of the
medication on the prescription (e.g. for heart), to enable the pharmacist to include this
information on the label.
REFILLS
When a patient is stabilized on medication, refills, where permitted by law, should be
indicated on the prescription. Authorization should allow for sufficient refills until the
patient's next appointment, to a maximum of one year. If refills are not properly indicated
on the prescription, the pharmacist must by law, contact the prescriber for refill
authorization.
Specific regulations apply to various categories of prescription drugs. Your pharmacist
would be pleased to review the regulations with you. Please refer to the following chart
for a summary of requirements.
SUBSTITUTION
Unless the prescriber directs otherwise, the pharmacist may select and dispense an
interchangeable pharmaceutical product, other than the one prescribed, according to the
Saskatchewan Prescription Drug Plan Formulary. An interchangeable pharmaceutical
product is a product containing a drug or drugs in the same amounts, of the same active
ingredients, in the same dosage form as that directed by the prescription. Those which
conform to the criteria for interchangeability determined by the Saskatchewan Formulary
Committee are designated as "interchangeable" in the Saskatchewan Formulary Listing.
A prescriber may request that a specific brand of a drug be dispensed by indicating in his
own handwriting at the time of issuing a written prescription, or verbally at the time of
giving a verbal prescription, No Substitution, No Sub, or N/S. In most cases, the patient
is responsible for the incremental cost of "No Sub" prescriptions.
TRANSFER OF PRESCRIPTIONS
Schedule F drugs may be transferred from one pharmacist to another at the request of a
patient. Prescriptions for benzodiazepines and other targeted substances may be
transferred once. Prescriptions for Schedule 2 and 3 drugs and Narcotic and Controlled
Drugs may NOT be transferred.
When a prescription is transferred, the original prescription shall remain on file, and on it
shall be entered:
1. the date of the transfer;
2. an indication that no further sales nor transfers may be made under the prescription
(i.e. the word "VOID");
3. the name of the pharmacy and pharmacist to whom the prescription was transferred;
4. the patient profile, manual or electronic, must also indicate the prescription is "VOID".
The pharmacist receiving the transferred prescription shall indicate:
1.
2.
3.
4.
the name of the pharmacist transferring the prescription;
the name and address of the pharmacy transferring the prescription;
the number of authorized repeats remaining, if any;
the date of the last fill or refill.
293
Saskatchewan Pharmaceutical Association
PRESCRIPTION REGULATIONS
A synopsis* of Federal and Provincial Acts and Regulations
governing the Distribution of Drugs by Prescription in Saskatchewan
CLASS
NARCOTIC DRUG**
Examples: Codeine, Demerol, Morphine,
Novahistex DH, Percodan, Tussionex, Tylenol
#4, Lomotil, Darvon-N, Talwin, 642's, etc.
DESCRIPTION
REQUIREMENTS
All straight narcotics, all narcotic drugs or compounds for
parenteral use. Compounds containing more than one
narcotic or compounds with less than two non-narcotic
ingredients. All products containing diacetylmorphine,
oxycodone, hydrocodone, methadone, or pentazocine.
Written prescription signed and dated by a
practitioner.
**Refer to Triplicate Prescription Program.
Refer to the Controlled Drugs and Substances Act and to the
Schedule to the Narcotic Control Regulations.
VERBAL PRESCRIPTION NARCOTIC**
Examples: A.C. with Codeine 15, 30, 60 mg,
Fiorinal C 1/4, C1/2, Tylenol #2 and #3, 292's,
etc.
A combination product not intended for parenteral use,
containing one narcotic (only) and two or more non-narcotic
drugs in therapeutic dose, except products containing
diacetylmorphine, oxycodone, hydrocodone, methadone, or
pentazocine.
Refer to the Controlled Drugs and Substances Act and to
the Schedule to the Narcotic Control Regulations.
CONTROLLED DRUGS - LEVEL I**
Examples: Dexedrine, Ritalin, Seconal, etc.
Those drugs listed in Part I of the Schedule to Part G of the
Food and Drug Regulations and Schedule III of the
Controlled Drugs and Substances Act. They include
amphetamines, methaqualone, methylphenidate,
phendimetrazine, phenmetrazine, pentobarbital and
secobarbital.
Written or verbal prescription** from a
practitioner. Verbal prescription must be reduced
to writing by a pharmacist showing:
- name and address of patient;
- name, initials and address of prescriber;
- name, quantity, and form of drug(s);
- directions for use;
- date;
- prescription number;
- name or initials of pharmacist
**Refer to Triplicate Prescription Program
CONTROLLED DRUG PREPARATION LEVEL I**
Examples: Cafergot PB, etc.
A combination containing a controlled drug - LeveI I - as
described above, and one or more active medicinal
ingredients, in a recognized therapeutic dose, other than a
narcotic or controlled drug.
CONTROLLED DRUGS - LEVEL II**
Examples: Phenobarb, Amytal, Butisol,
Tenuate, Ionamin, Anabolic Steroids (i.e.
Delatestryl), etc.
Those drugs listed in Parts II & III of the Schedule to Part G
of the Food and Drug Regulations and Schedule IV of the
Controlled Drugs and Substances Act. They include:
barbituric acid and its salts and derivatives (except
secobarbital and pentobarbital), butorphanol,
chlorphentermine, diethylpropion, nalbuphine, phentermine,
thiobarbituric acid.
CONTROLLED DRUG PREPARATION LEVEL II
Examples: Fiorinal**, Anabolic Steroids,
(i.e. Climacteron), etc.
A combination containing a controlled drug - Level II - as
described above, and one or more active medicinal
ingredients, in a recognized therapeutic dose, other than a
narcotic or controlled drug.
TARGETED DRUGS
Examples: Benzodiazepines (except for
Flunitrazepam, Clozapine & Olanzapine),
Clotiazepam, Ethchlorvynol, Ethinamate,
Fencamamin, Mazindol, Mefernorex,
Meprobamate, Methnprylon, Pipradol
Those drugs listed in Schedule I of the Benzodiazepines
and Other Targeted Substances Regulations.
Written or verbal prescription from practitioner.
Verbal prescriptions must be reduced to writing by
a pharmacist showing date, prescription number,
patient's name and address, name and quantity of
drug(s), directions for use, prescriber's name,
name and initials of pharmacist, and number of
refills (if any).
PRESCRIPTION DRUGS
Those drugs listed in Schedule I of the Bylaws to the
Pharmacy Act, 1996, including drugs listed in Schedule F to
the Food and Drug Regulations.
Written or verbal prescription from practitioner.
Verbal prescriptions must be reduced to writing by
a pharmacist showing date, prescription number,
patient's name and address, name and quantity of
drug(s), directions for use, prescriber's name,
name and initials of pharmacist, and number of
refills (if any).
TRANSFER OF PRESCRIPTIONS
Only prescriptions for Schedule I and
Targeted drugs may be transferred from one
pharmacist to another at the request of a
patient. Prescriptions for Narcotic and
Controlled Drugs may NOT be transferred.
294
As immediately above, plus, in the case of verbal
prescriptions:
- number and frequency of refills (if any)
authorized.
The pharmacist receiving the transferred prescription shall indicate:
1. the name of the pharmacist transferring the prescription;
2. the name and address of the pharmacy transferring the prescription;
3. the number of authorized repeats remaining, if any;
4. the date of the last fill or refill.
* This synopsis is a condensation of some of the pertinent Acts and Regulations. Users of the chart are reminded that it has been compiled for convenient
reference only and that the official legislation should always be consulted for the purposes of interpreting and applying the laws.
** Triplicate Prescription Program: Effective August 1, 1988, a specially designed prescription form must be used by a prescriber to write a prescription for any
of the medications on the panel of monitored drugs. Pharmacists may not fill a prescription for any of these drugs written on any other form. Verbal prescriptions
may not be accepted for any of the drugs listed on this panel of drugs. Please refer to the Triplicate Prescription Program Newsletter for details.
*** RECORDS - Narcotic Register includes either the approved manual or electronic (i.e. pharmacy computer) version.
SOURCE: Saskatchewan Pharmaceutical Association
REPEATS
RECORDS***
No Repeats.
All re-orders must be new, written prescriptions. However, a
prescription may be dispensed in divided portions, subject to
professional discretion.
All receipts and all sales (except prescription sales of dextropropoxyphene) entered in
Narcotic Register. Prescriptions filed in order of date and number in a special file
designated for Narcotics and Controlled Drugs. If a part-fill is made, all records, including
the prescription itself, and the Narcotic Register, must reflect the actual amount dispensed.
Further part-fills must be documented and cross-referenced to the original prescription.
No Repeats.
All orders must be new, written prescriptions. However,
a prescription may be dispensed in divided portions,
subject to professional discretion.
Receipts - entry required in Narcotic Register.
Sales - no entry required for sales pursuant to prescriptions, but emergency supplies
provided to another pharmacist and returns to licensed dealers must be recorded in sales
portion of Register. Prescriptions filed in order of date and number in a special file
designated for Narcotics and Controlled Drugs.
No repeats are allowed if original prescription is verbal. If
written, the original prescription may be repeated if the
prescriber has indicated in writing the number and
frequency of repeats.
All receipts and all sales entered in Narcotic Register.
Prescriptions filed in order of date and number in a special file designated for Narcotics and
Controlled Drugs.
**Refer to the Triplicate Prescription Program.
Receipts - entry required in Narcotic Register.
Sales - no entry required in Narcotic Register for sales pursuant to prescriptions, but emergency
supplies provided to another pharmacist and returns to licensed dealers must be recorded in
sales portion of Register. Prescriptions filed in order of date and number in a special file
designated for Narcotics and Controlled Drugs.
Repeats may be authorized on original prescription whether
written or verbal, but authorization must indicate number
and frequency of repeats.
Receipts - entry required in Narcotic Register or invoices must be available to substantiate
receipt.
Sales - no entry required in Narcotic Register for sales pursuant to prescriptions, but
emergency supplies provided to another pharmacist and returns to licensed dealers must be
recorded in sales portion of Register. Prescriptions filed in order of date and number in
special file designated for Narcotics and Controlled Drugs.
Repeats may be authorized on original prescription whether
written or verbal, but authorization must be for a specific
number of refills. Refills are permitted only if less than 1 year
has elapsed since the date on which the prescription was
issued.
Receipts - entry required in Narcotic Register or invoices must be available to substantiate
receipt.
Prescriptions filed in the regular Schedule I file and must be retained for at least two years
from the date of the last fill or refill.
"PRN" is not valid authority for repeats.
Repeats may be authorized on original prescription
whether written or verbal, but authorization must be for a
specific number of refills.
No entries required in Narcotic Register. Prescriptions filed in regular file and must be
retained for at least two years from date of last fill or refill.
"PRN" is not valid authority for repeats.
When a prescription is transferred, the original prescription shall remain on file, and on it shall be entered:
1. the date of the transfer;
2. an indication that no further sales nor transfers may be made under the prescription (i.e. the word "VOID");
3. the name of the pharmacy and pharmacist to whom the prescription was transferred;
4. the patient profile, manual or electronic, must also indicate the prescription is "VOID".
295
APPENDIX D
GUIDELINES FOR REPORTING ADVERSE DRUG REACTIONS
DEFINITION OF AN ADVERSE DRUG REACTION (ADR):
"Any undesirable patient effect suspected to be associated with drug use."
WHICH ADVERSE DRUG REACTIONS SHOULD BE REPORTED?
Proof a drug caused an undesirable patient effect (causality) is NOT a requirement for
reporting an adverse drug reaction. If an adverse event is suspected of being drugrelated, particularly if the event is unusual in the context of the illness, it should be
reported.
Practitioners should report to SaskADR:
•
all suspected adverse drug reactions which are unexpected. An unexpected
adverse drug reaction is an undesirable patient effect which is not consistent with
product information or labelling;
•
all suspected adverse drug reactions which are serious. A serious adverse drug
reaction is an undesirable patient effect which contributes to significant disability or
illness. All adverse drug reactions which result in, or prolong hospitalization or
require significant medical intervention should be considered serious;
•
all suspected adverse reactions to recently marketed drugs regardless of their
nature or severity. A recently marketed drug is considered to be commercially
available for 5 (five) years or less.
HOW TO REPORT A SUSPECTED ADVERSE DRUG REACTION TO SaskADR:
Adverse drug reaction reports from Saskatchewan practitioners should be sent to the
Saskatchewan Adverse Drug Reaction Reporting Centre (SaskADR) located at the Dial
Access Drug Information Service, College of Pharmacy, University of Saskatchewan.
Please report suspected adverse drug reactions as soon as possible after detection
even if all details are not known at the time of the report. Staff at SaskADR will follow-up
for further information if required.
•
Complete a written ADR report form (next page). Record all information that is
available and mail to SaskADR. Information may be attached to the report form if
insufficient space is available for complete documentation. Additional forms may be
obtained from SaskADR at the following address:
SaskADR Centre
Dial Access Drug Information Service
110 Science Place
University of Saskatchewan
Saskatoon, S7N 5C9
Fax: (306) 966-6377
OR
•
provide a verbal report to SaskADR by phoning Dial Access Drug Information at tollfree 1-800-667-3425 or (in Saskatoon) at 966-6340 or 966-6329. Office hours are
9:00 a.m. to 5:00 p.m., Monday to Friday, excluding statutory holidays.
296
Health
Canada
l
l
Santé
Canada
Canadian Adverse Drug Reaction Monitoring Program
See reverse for return address.
La version française de ce document
est disponible sur demande. Voir au
verso pour connaître le centre à contacter.
A. Patient Information
1. Patient identifier
Chart Number
DD
2. Age at time of
reaction
__________ or
Date of birth
MM
YYYY
3. Sex
Male
Female
4. Height
5. Weight
_____ feet
_____ lbs
or
or
_____ cm
_____ kgs
B. Adverse Reaction
1. Outcome attributed to adverse reaction (check all that apply)
Death ____________ (dd / mm / yyyy)
Disability
Life-threatening
Congenital malformation
Hospitalization
Hospitalization - prolonged
2.
Date and time of reaction
DD
MM
YYYY
Required intervention to prevent
damage / permanent impairment
Other: ____________________
3.
DD
Therapeutic
Products
Programme
Report of suspected adverse reaction
due to drug products marketed in Canada
(Vaccines excluded)
Date of this report
MM
YYYY
PROTECTED
C. Suspected drug product(s)
(See "How to report" section on reverse)
1. Name (give labelled strength & manufacturer, if known).
#1
____________________________________________________________________
#2
____________________________________________________________________
2. Dose, frequency & route used
#1
3. Therapy dates (if unknown, give duration)
#1 From (dd / mm / yyyy) - To (dd / mm / yyyy)
#2
#2
4. Indication for use of suspected drug
product
#1
5. Reaction abated after use
stopped or dose reduced
#1
Yes
No
Doesn't apply
#2
Yes
No
Doesn't apply
#2
4. Describe reaction or problem
6. Lot # (if known)
#1
_______________
#2
7. Exp. date (if known) 8. Reaction reappeared after
reintroduction
#1 (dd / mm / yyyy)
_______________
#1
Yes
No
Doesn't apply
#2
#2
Yes
No
Doesn't apply
9. Concomitant drugs (name, dose, frequency and route used) and therapy dates
(dd / mm / yyyy) (exclude treatment of reaction)
10. Treatment of adverse reaction (drugs and / or therapy), including dates
(dd / mm / yyyy)
5. Relevant tests / laboratory data (including dates (dd / mm / yyyy)
D. Reporter
(See "Confidentiality" section on reverse)
1. Name, address & phone number.
6. Other relevant history, including preexisting medical conditions
(e.g. allergies, pregnancy, smoking and alcohol use, hepatic / renal dysfunction)
2. Health professional? 3.Occupation
Yes
Submission of a report does not constitute an admission that medical
personnel or the product caused or contributed to the adverse reaction.
HC/SC 4016 (12-98)
No
For TPP use only
4. Also reported to
manufacturer?
Yes
No
Return this form to the address listed for your region
ADVERSE DRUG REACTION REPORTING GUIDELINES
What to report?
An adverse drug reaction (ADR) is a noxious and unintended response to a drug which occurs with use or testing for the diagnosis, treatment or prevention of a disease or the
modification of an organic function. This includes any undesirable patient effect suspected to be associated with drug use. ADRs as a result of prescription, non-prescription,
biological (including blood products), complementary medicines (including herbals) and radiopharmaceutical drug products are monitored. Drug abuse, drug overdoses, drug
interactions and unusual lack of therapeutic efficacy are also considered to be reportable as ADRs.
ADR reports are, for the most part, only suspected associations. A temporal or possible association is sufficient for a report to be made. Reporting an ADR does not imply a
causal link.
ADRs that should be reported include all suspected adverse drug reactions which are:
"
unexpected, regardless of their severity i.e. not consistent with product information or labelling; or
"
serious, whether expected or not; or
"
reactions to recently marketed drugs (on the market for less than five years) regardless of their nature or severity.
The Canadian Regulations pertaining to reporting ADRs for marketed drug products define a serious adverse drug reaction as "a noxious and unintended response to a drug,
which occurs at any dose and requires in-patient hospitalization or prolongation of existing hospitalization, causes congenital malformation, results in persistent or significant
disability or incapacity, is life-threatening or results in death".
Confidentiality of ADR Information
Any information related to the reporter and patient identifiers is kept confidential.
How to report?
To report a suspected ADR for drug products marketed in Canada, health professionals should complete a copy of the ADR Reporting Form (Report of suspected adverse
reaction due to drug products marketed in Canada (Vaccines excluded) (HC/SC 4016 (12-98)). This form may be obtained from your Regional Centre or from the
National ADR Unit (see addresses below), and is included in the Canadian Compendium of Pharmaceuticals and Specialities (CPS).
Fill in the sections that apply to the report as completely as possible, using a separate form for each patient. Additional pages may be attached if additional space is required.
The success of the program depends on the quality and accuracy of the information sent in by the reporter.
Up to two (2) suspected drug products may be reported on one form (#1 = first suspected drug product, #2 = second suspected drug product). Attach an additional form if
there are more than two suspected drug products for the reported adverse reaction.
How to deal with follow-up information for an ADR that has already been reported?
Any follow-up information for an ADR that has already been reported can be sent on another ADR form, or it can be communicated by telephone, fax or e-mail if convenient to
the appropriate address for your region (see addresses below). So that this information can be matched with the original report, indicate that it is follow-up information, the
date of the original report and the report case number if known. It is very important that follow-up reports are identified and linked to the original report.
What about reporting ADRs to the Manufacturer?
Health professionals may also report ADRs to the manufacturer. Indicate on your ADR report sent to Health Canada if a case was also reported to the manufacturer.
For more information on the ADR monitoring program, additional copies of ADR reporting forms or to report an ADR, physicians, pharmacists and other health professionals
are invited to contact the addresses listed for your region.
British Columbia
Ontario
BC Regional ADR Centre
c/o BC Drug and Poison Information Centre
1081 Burrard St.
Vancouver, British Columbia V6Z 1Y6
Tel: (604) 631-5625
Fax: (604) 631-5262
adr@dpic.bc.ca
Ontario Regional ADR Centre
LonDIS Drug Information Centre
London Health Sciences Centre
339 Windermere Road
London, Ontario N6A 5A5
Tel: (519) 663-8801 Fax: (519) 663-2968
adr@lhsc.on.ca
Saskatchewan
Québec
All other provinces and territories
Sask ADR Regional Centre
College of Pharmacy and Nutrition
110 Science Place
Saskatoon, Saskatchewan S7N 5C9
Tel: (306) 966-6340 or (800) 667-3425
Fax: (306) 966-6377
vogt@duke.usask.ca
Québec Regional ADR Centre
Drug Information Centre
Hôpital du Sacré-Coeur de Montréal
5400, boul. Gouin ouest
Montréal, Québec H4J 1C5
Tel: (514) 338-2961 or (888) 265-7692
Fax: (514) 338-3670
cip.hscm@sympatico.ca
National ADR Unit
Continuing Assessment Division
Bureau of Drug Surveillance
Therapeutic Products Programme
Finance Building
Tunney's Pasture
AL 0201C2
Ottawa, Ontario K1A 1B9
Tel: (613) 957-0337 Fax: (613) 957-0335
cadrmp@hc-sc.gc.ca
For Therapeutic Products Programme Use Only
New Brunswick, Nova Scotia
Prince Edward Island and Newfoundland
Atlantic Regional ADR Centre
c/o Queen Elizabeth II Health Sciences Centre
1796 Summer Street, Rm 2421
Halifax, Nova Scotia B3H 3A7
Tel: (902) 473-7171 Fax: (902) 473-8612
rxkls1@qe2-hsc.ns.ca
Health
Canada
l
l
Santé
Canada
Canadian Adverse Drug Reaction Monitoring Program
See reverse for return address.
La version française de ce document
est disponible sur demande. Voir au
verso pour connaître le centre à contacter.
A. Patient Information
1. Patient identifier
Chart Number
DD
2. Age at time of
reaction
__________ or
Date of birth
MM
YYYY
3. Sex
Male
Female
4. Height
5. Weight
_____ feet
_____ lbs
or
or
_____ cm
_____ kgs
B. Adverse Reaction
1. Outcome attributed to adverse reaction (check all that apply)
Death ____________ (dd / mm / yyyy)
Disability
Life-threatening
Congenital malformation
Hospitalization
Hospitalization - prolonged
2.
Date and time of reaction
DD
MM
YYYY
Required intervention to prevent
damage / permanent impairment
Other: ____________________
3.
DD
Therapeutic
Products
Programme
Report of suspected adverse reaction
due to drug products marketed in Canada
(Vaccines excluded)
Date of this report
MM
YYYY
PROTECTED
C. Suspected drug product(s)
(See "How to report" section on reverse)
1. Name (give labelled strength & manufacturer, if known).
#1
____________________________________________________________________
#2
____________________________________________________________________
2. Dose, frequency & route used
#1
3. Therapy dates (if unknown, give duration)
#1 From (dd / mm / yyyy) - To (dd / mm / yyyy)
#2
#2
4. Indication for use of suspected drug
product
#1
5. Reaction abated after use
stopped or dose reduced
#1
Yes
No
Doesn't apply
#2
Yes
No
Doesn't apply
#2
4. Describe reaction or problem
6. Lot # (if known)
#1
_______________
#2
7. Exp. date (if known) 8. Reaction reappeared after
reintroduction
#1 (dd / mm / yyyy)
_______________
#1
Yes
No
Doesn't apply
#2
#2
Yes
No
Doesn't apply
9. Concomitant drugs (name, dose, frequency and route used) and therapy dates
(dd / mm / yyyy) (exclude treatment of reaction)
10. Treatment of adverse reaction (drugs and / or therapy), including dates
(dd / mm / yyyy)
5. Relevant tests / laboratory data (including dates (dd / mm / yyyy)
D. Reporter
(See "Confidentiality" section on reverse)
1. Name, address & phone number.
6. Other relevant history, including preexisting medical conditions
(e.g. allergies, pregnancy, smoking and alcohol use, hepatic / renal dysfunction)
2. Health professional? 3.Occupation
Yes
Submission of a report does not constitute an admission that medical
personnel or the product caused or contributed to the adverse reaction.
HC/SC 4016 (12-98)
No
For TPP use only
4. Also reported to
manufacturer?
Yes
No
Return this form to the address listed for your region
ADVERSE DRUG REACTION REPORTING GUIDELINES
What to report?
An adverse drug reaction (ADR) is a noxious and unintended response to a drug which occurs with use or testing for the diagnosis, treatment or prevention of a disease or the
modification of an organic function. This includes any undesirable patient effect suspected to be associated with drug use. ADRs as a result of prescription, non-prescription,
biological (including blood products), complementary medicines (including herbals) and radiopharmaceutical drug products are monitored. Drug abuse, drug overdoses, drug
interactions and unusual lack of therapeutic efficacy are also considered to be reportable as ADRs.
ADR reports are, for the most part, only suspected associations. A temporal or possible association is sufficient for a report to be made. Reporting an ADR does not imply a
causal link.
ADRs that should be reported include all suspected adverse drug reactions which are:
"
unexpected, regardless of their severity i.e. not consistent with product information or labelling; or
"
serious, whether expected or not; or
"
reactions to recently marketed drugs (on the market for less than five years) regardless of their nature or severity.
The Canadian Regulations pertaining to reporting ADRs for marketed drug products define a serious adverse drug reaction as "a noxious and unintended response to a drug,
which occurs at any dose and requires in-patient hospitalization or prolongation of existing hospitalization, causes congenital malformation, results in persistent or significant
disability or incapacity, is life-threatening or results in death".
Confidentiality of ADR Information
Any information related to the reporter and patient identifiers is kept confidential.
How to report?
To report a suspected ADR for drug products marketed in Canada, health professionals should complete a copy of the ADR Reporting Form (Report of suspected adverse
reaction due to drug products marketed in Canada (Vaccines excluded) (HC/SC 4016 (12-98)). This form may be obtained from your Regional Centre or from the
National ADR Unit (see addresses below), and is included in the Canadian Compendium of Pharmaceuticals and Specialities (CPS).
Fill in the sections that apply to the report as completely as possible, using a separate form for each patient. Additional pages may be attached if additional space is required.
The success of the program depends on the quality and accuracy of the information sent in by the reporter.
Up to two (2) suspected drug products may be reported on one form (#1 = first suspected drug product, #2 = second suspected drug product). Attach an additional form if
there are more than two suspected drug products for the reported adverse reaction.
How to deal with follow-up information for an ADR that has already been reported?
Any follow-up information for an ADR that has already been reported can be sent on another ADR form, or it can be communicated by telephone, fax or e-mail if convenient to
the appropriate address for your region (see addresses below). So that this information can be matched with the original report, indicate that it is follow-up information, the
date of the original report and the report case number if known. It is very important that follow-up reports are identified and linked to the original report.
What about reporting ADRs to the Manufacturer?
Health professionals may also report ADRs to the manufacturer. Indicate on your ADR report sent to Health Canada if a case was also reported to the manufacturer.
For more information on the ADR monitoring program, additional copies of ADR reporting forms or to report an ADR, physicians, pharmacists and other health professionals
are invited to contact the addresses listed for your region.
British Columbia
Ontario
BC Regional ADR Centre
c/o BC Drug and Poison Information Centre
1081 Burrard St.
Vancouver, British Columbia V6Z 1Y6
Tel: (604) 631-5625
Fax: (604) 631-5262
adr@dpic.bc.ca
Ontario Regional ADR Centre
LonDIS Drug Information Centre
London Health Sciences Centre
339 Windermere Road
London, Ontario N6A 5A5
Tel: (519) 663-8801 Fax: (519) 663-2968
adr@lhsc.on.ca
Saskatchewan
Québec
All other provinces and territories
Sask ADR Regional Centre
College of Pharmacy and Nutrition
110 Science Place
Saskatoon, Saskatchewan S7N 5C9
Tel: (306) 966-6340 or (800) 667-3425
Fax: (306) 966-6377
vogt@duke.usask.ca
Québec Regional ADR Centre
Hôpital du Sacré-Coeur de Montréal
5400, boul. Gouin ouest
Montréal, Québec H4J 1C5
Tel: (514) 338-2961 or (888) 265-7692
Fax: (514) 338-3670
cip.hscm@sympatico.ca
National ADR Unit
Continuing Assessment Division
Bureau of Drug Surveillance
Therapeutic Products Programme
Finance Building
Tunney's Pasture
AL 0201C2
Ottawa, Ontario K1A 1B9
Tel: (613) 957-0337 Fax: (613) 957-0335
cadrmp@hc-sc.gc.ca
For Therapeutic Products Programme Use Only
New Brunswick, Nova Scotia
Prince Edward Island and Newfoundland
Atlantic Regional ADR Centre
c/o Queen Elizabeth II Health Sciences Centre
1796 Summer Street, Rm 2421
Halifax, Nova Scotia B3H 3A7
Tel: (902) 473-7171 Fax: (902) 473-8612
rxkls1@qe2-hsc.ns.ca
APPENDIX E
SPECIAL COVERAGES
INCOME BASED DRUG BENEFITS – SPECIAL SUPPORT PROGRAM
An income based program was implemented on July 1, 2002 to replace the previous
$850 semi-annual deductible. Under this program families will pay the full cost of their
prescriptions unless they apply to the income based program, the Special Support
Program.
An expanded safety net program, called the Special Support Program, has been
designed to help those whose benefit drug costs are high in relation to their income.
Based on the income information provided on the application form (with photocopies of
income tax) along with Drug Plan records, the Drug Plan will calculate a family threshold
deductible and may establish a consumer co-payment to reduce the consumer's share of
drug costs.
Benefits are determined by family income (adjusted for number of dependents) and
actual benefit drug costs. Residents must apply for Special Support annually.
Residents can call the Drug Plan at 787-3317 (in Regina) or toll-free at 1-800-667-7581
and request an application form be sent to them or they may pick up a form at their
community pharmacy. The benefit period is July 1 to June 30.
If the family income or medication costs change during the coverage period, the
consumer may wish to contact the Drug Plan for a reassessment of coverage:
1. changes in income must be made in writing with supporting documentation;
2. a request to review the assessment should be made in writing; or
3. the pharmacist may telephone requesting the coverage be reviewed because of new
drugs.
Income Supplement Recipients
Families receiving Family Health Benefits, and seniors receiving the Saskatchewan
Income Plan supplement (S.I.P.) or receiving the federal Guaranteed Income Supplement
(G.I.S.) and residing in a special care home will pay a $100 semi-annual deductible.
Other seniors receiving G.I.S. (ie. living in the community) have a $200 semi-annual
deductible. (If these patients have high drug costs they may also apply for Special
Support.) Other seniors are treated the same as non-seniors, based on their income and
drug cost.
Children under 18 years of age of families receiving Family Health Benefits are eligible
for the same benefits as Supplementary Health beneficiaries with Plan Two coverage.
This means all covered drugs will be provided at no charge. Also certain dental services,
medical supplies and appliances, optical services, chiropractic services, and emergency
medical transportation costs will be covered.
Adults receiving Family Health Benefits are eligible for chiropractic services and an eye
examination every two years.
Inquiries regarding benefits, contact the Supplementary Health Program:
Regina: 787-3125
Toll-free: 1-800-266-0695
Inquiries regarding prescription drugs should be directed to the Drug Plan:
Regina: 787-3317
Toll-free: 1-800-667-7581
301
SUMMARY OF FAMILY HEALTH BENEFITS FOR FAMILIES RECEIVING
SASKATCHEWAN CHILD BENEFIT AND/OR
SASKATCHEWAN EMPLOYMENT SUPPLEMENT
HEALTH BENEFITS
CHILDREN
PARENTS OR
GUARDIANS
Dental Coverage
Coverage of most services
Coverage not provided
Optometric Services
Eye examinations once a
year
Eye examinations covered
once every two years
Basic Eyeglasses
Emergency Ambulance
Covered
Medical Supplies
Basic coverage, some
items require prior approval
Chiropractic Services
Covered
Covered
Drug Coverage
No charge for Formulary
drugs
$100 semi-annual family
deductible; 35% consumer
co-payment there after
Drug Plan Special Support
Program available if
provides better coverage
(Consumer must apply)
EMERGENCY ASSISTANCE
Eligibility
Residents who require immediate treatment with covered prescription drugs and are
unable to cover their share of the cost, may access emergency assistance. An eligible
beneficiary may obtain a limited supply of covered prescription drug(s) at a reduced cost.
The level of assistance provided will be in accordance with the consumer's ability to pay.
Request Process
During regular office hours, the patient's pharmacy may call the Drug Plan at 787-3317
(Regina) or toll-free at 1-800-667-7578 to provide the information needed to support the
request, as follows:
•
•
•
patient identification (health services number);
pharmacy identification (name, number);
name and cost of the drug(s) required immediately;
302
•
reason for the request, including evidence that other sources of credit or assistance
have been explored and are not available.
Following approval by the Drug Plan, the claims may be submitted via the on-line system.
The patient may obtain up to a one month supply of covered drug product(s) included in
the request. A completed " Special Support" form must be submitted for future
assistance.
Outside regular office hours, the pharmacy may provide up to a four day supply of
benefit drug products in an emergency situation. The paper claim will be honoured by
the Drug Plan at the rate of payment specified by the pharmacist. A completed "Request
for Special Support" form must be submitted for future assistance.
EXCEPTION DRUG STATUS PROGRAM
Please refer to Appendix A for detailed information and criteria for coverage of
medications under the Exception Drug Status Program. For general information
regarding Exception Drug Status, see "Notes Concerning the Formulary".
PALLIATIVE CARE COVERAGE
Definition of Palliative Care
Patients who are in the late stages of a terminal illness, where life expectancy is
measured in months, and for whom treatment aimed at cure or prolongation of life is no
longer deemed appropriate, but for whom care is aimed at improving or maintaining the
quality of remaining life (eg. management of symptoms such as pain, nausea and stress),
will be eligible for Drug Plan Palliative Care drug benefits. The patient's physician must
submit a completed Drug Plan" Request for Palliative Care Coverage" form to the Drug
Plan in order to register a patient for this program.
Drug Benefits under Palliative Care
A palliative care patient who is registered with the Drug Plan is entitled to receive
prescription drugs listed in the Saskatchewan Formulary at no charge to them. The
patient's pharmacy will bill the Drug Plan for 100% of the cost of benefit medications.
Coverage is also provided for some commonly used laxatives, on prescription request, to
patients registered under this program.
Exception Drug Status Drugs for Palliative Care Patients
Drugs listed under the Exception Drug Status program still require a separate physician
request on behalf of the patient. To be eligible for approval of Exception Drug Status
drugs, palliative care patients must meet the criteria as outlined in Appendix A of the
current Saskatchewan Formulary. The Drug Plan must be provided with all relevant
information to determine if the patient meets the criteria for the Exception Drug Status
drug being requested on the patient's behalf.
Provisional Approval of Palliative Care Coverage
Provisional approval may be granted in response to a telephoned request from the
pharmacy, the physician or social worker involved in the patient's care. At the time of the
request, the pharmacy or social worker must be in possession of a signed Palliative Care
form. After provisional coverage has been granted, the pharmacy or social worker must
forward the signed form to the Drug Plan. Provisional approval may be withheld by the
Drug Plan if the pharmacy or social worker is not in receipt of a signed form. All
303
physicians requesting provisional approval must provide the Drug Plan with a signed form
on the patient's behalf in a timely manner.
For provisional approval of Palliative Care, please contact the Drug Plan at 787-8744 to
arrange coverage.
Notification of Physician and Patient
Upon receipt of a signed Palliative Care form, notification letters are generated by the
Drug Plan, to the patient and the requesting physician.
Backdating of Palliative Care Coverage
Palliative Care coverage is routinely backdated 30 days from the date the form is
received by the Drug Plan. In certain cases where a patient is eligible for coverage but
application is inadvertently not made, the Drug Plan will consider backdating at the
physician's request, beyond this period.
Palliative Care Benefits under Health Districts
Patients, pharmacists or physicians should contact the home care office in their health
district to inquire about coverage provided by the district for dietary supplements and
other basic supplies.
"NO SUB" PRESCRIPTION DRUG COVERAGE
It is recognized that extremely rare cases may exist in which a person is not able to use a
particular brand of product. In such cases, the prescriber may request exemption from
full payment of incremental cost when a specific brand of drug in an interchangeable
category is found to be essential for a particular patient. There is no provision for
"blanket" exemptions. Each request must be patient and product specific.
The request may be submitted in writing or by telephone (787-8744 or toll-free
1-800-667-2549) and must provide sufficient details to permit thorough, objective
assessment.
S.A.I.L. COVERAGE (SASKATCHEWAN AIDS TO INDEPENDENT LIVING)
S.A.I.L. beneficiaries include persons with cystic fibrosis, chronic end-stage renal disease
and paraplegics. S.A.I.L. provides coverage for Formulary and non-Formulary diseaserelated drugs used by these beneficiaries. For general inquiries regarding this program,
telephone (306) 787-7121. For drug inquiries, telephone (306) 787-3314.
SASKATCHEWAN CANCER AGENCY
Prescriptions for drugs covered by the Saskatchewan Cancer Agency are provided free
of charge to registered cancer patients by either the Allan Blair Cancer Centre Pharmacy
in Regina (telephone: (306) 766-2816) or the Saskatoon Cancer Centre Pharmacy
(telephone: (306) 655-2680). These drugs would be provided when requested by a
clinic oncologist or a physician working in association with the Cancer Agency. These
drugs are not covered by the Drug Plan. Examples are flutamide, cyproterone and
ondansetron. Please note that dexamethasone 4mg when used in the treatment of
registered cancer patients would be provided by the Saskatchewan Cancer Agency
through the two cancer centre pharmacies. When dexamethasone 4mg is used for
control of symptoms in the palliative patient, the cost is covered by the Drug Plan, when
the patient has been registered under the Drug Plan Palliative Care program.
304
SOCIAL ASSISTANCE BENEFICIARIES
Plan One Drug Coverage
Holders of Supplementary Health cards designated as "Plan One" may obtain
prescriptions for Formulary drugs at a nominal consumer charge, currently no more than
$2.00 per prescription. In addition, they may obtain the following prescribed drugs
without charge:
insulin, oral hypoglycemics, injectable Vitamin B12, oral contraceptives, allergenic
extracts, and products used in megavitamin therapy.
Beneficiaries under the age of 18 may obtain Formulary drugs or approved Exception
Drug Status drugs without charge.
Cost of allergenic extracts and products used in megavitamin therapy are covered by the
Supplementary Health Program of Saskatchewan Health. All of the other products listed
above are covered and processed through the Drug Plan.
Plan Two Drug Coverage
Beneficiaries requiring several Formulary drugs on a regular basis can be considered for
"Plan Two" drug coverage. Plan Two coverage may be initiated by contacting the Drug
Plan at 787-8744 or (toll-free) 1-800-667-7581. The request can be made by the patient
or a health professional (ie. physician, social worker).
Holders of Supplementary Health cards designated as "Plan Two" may obtain the
products available under "Plan One" together with any Formulary drugs or approved
Exception Drug Status drugs, without charge.
Plan Three Drug Coverage
Holders of Supplementary Health cards designated as "Plan Three" may obtain, in
addition to drugs available under the Drug Plan, certain other prescribed drugs at no
charge. The cost of such drugs is covered by the Supplementary Health Program of
Saskatchewan Health. All pharmacy claims are processed by the Drug Plan.
Pharmacies may contact the Drug Plan at 787-3314 (Regina) or
1-800-667-7578 with inquires regarding Plan Three drug coverage.
(toll-free)
Special Drug Authorization
In addition to Formulary and Exception Drug Status benefits, Social Assistance
beneficiaries (Plan One and Plan Two) may be eligible for coverage of a selected panel
of products under the Supplementary Health Program through the Special Drug
Authorization process. Selected over-the-counter (OTC) products which are currently
benefits for Plan Three beneficiaries could be considered for coverage for Plan One and
Plan Two beneficiaries on a case-by-case basis. The prescriber must submit a request
on the patient's behalf. Requests may be submitted in writing or by telephone at
(306) 787-8744 or (toll-free) 1-800-667-2549.
305
APPENDIX F
TRIPLICATE PRESCRIPTION PROGRAM
PARTICIPANTS:
• Saskatchewan Pharmaceutical Association
• College of Physicians & Surgeons of Saskatchewan
• College of Dental Surgeons of Saskatchewan
OBJECTIVE:
To reduce the abuse and diversion of a select panel of prescription drugs.
PROGRAM CAPABILITY
The Triplicate Prescription program provides the College of Physicians & Surgeons with
the ability to:
•
•
•
•
•
•
identify patients who may be double doctoring or drug shopping;
upon request from the prescriber or pharmacist, provide accurate and up-to-date
prescribing information;
detect changing trends among the drug shopping patient population;
observe the prescribing practices of physicians and dentists and the dispensing
activities of pharmacies and provide advice to prevent serious problems from
developing;
generate prescriber, patient and pharmacy profiles relevant to the panel of monitored
drugs;
generate statistics and reports relevant to the panel of monitored drugs.
PROCESS
A specially designed prescription form must be used to write a prescription for any of the
medications included on the appended list. Pharmacists cannot fill a prescription for any
of these drugs written on any other form. Verbal prescriptions cannot be accepted for
any of these products. Faxed prescriptions are acceptable if done according to published
guidelines for faxing prescriptions.
PRESCRIBER PARTICIPATION
Physicians and dentists who wish to prescribe any of the medications on the panel of
monitored drugs must subscribe to the program by ordering their triplicate prescription
forms from the College of Physicians & Surgeons. Prescribers without these forms
cannot prescribe the monitored drugs.
GENERAL INFORMATION
The prescriber will complete the prescription form according to instructions. The patient
will receive the original prescription plus one copy. The patient will present the original
and copy to the pharmacist for dispensing. Upon receiving the medication, the patient or
the patient's agent will sign the form in the space provided. The pharmacist completes
the lower portion of the forms and retains the original. The network will receive and store
the information on the existing panel of formulary drugs for Drug Plan beneficiaries only.
Pharmacists are asked to continue to mail the College copy for all other beneficiaries and
drugs. This is done at least once per week. (The Saskatchewan Pharmaceutical
Association distributes self-addressed envelopes for this purpose.)
Upon receipt of the prescription copy, the College of Physicians & Surgeons enters the
information into their computer system.
306
DISPENSING INFORMATION
Prescriptions for the listed drugs must be written on a triplicate prescription form.
Prescriptions that are issued incompletely or inaccurately or are issued in any manner
which is contrary to the requirements of the Triplicate Prescription Program are rejected.
The following information must be complete on the prescription presented at the
pharmacy:
•
•
•
•
date (the prescription is valid for only 3 days from date of issue);
patient's name and address;
personal health number;
printed name of the prescriber.
The pharmacist enters the following information before sending the copy to the College:
•
•
•
•
•
prescription number;
date of filling the prescription;
price charged (optional);
dispensing pharmacist's signature or initials;
dispensing pharmacist's certificate (i.e. membership) number.
The prescription form must be signed by the patient (or agent) upon receipt of the
dispensed prescription. The signature must appear on the College copy.
ADDITIONAL INFORMATION
The Triplicate Prescription Program does not apply to orders issued in licensed special
care homes.
Only those products included in the panel of monitored drugs can be prescribed on the
triplicate form, and only one of those medications can be prescribed per form.
Part-fills are not encouraged but are acceptable subject to the usual legal and recordkeeping requirement. Under the program, every part-fill must be documented with the
original prescription number and the form number (upper right hand corner). The College
copy of the original prescription must be sent to the College of Physicians & Surgeons
immediately after the first fill. No subsequent refill information is required by the College.
Triplicate prescription pads are assigned numerically for the individual prescriber's use
and cannot be exchanged between practitioners. The prescriber is expected to print his
name, address and prescriber number on the form.
If a prescriber or pharmacist is concerned about a patient's drug history, he/she may
contact the College personally for confidential information at (306) 244-8778.
Prescriptions written at hospital emergency outpatient departments must be written on a
triplicate form if one of the monitored products is prescribed for an outpatient.
If a patient does not have the personal health number available and cannot readily obtain
it, the prescriber is expected to ask for identification and accurately fill in the remaining
identifiers on the form. Under these circumstances the pharmacist may fill the
prescription if this number is absent, but the remaining identifiers are in place.
307
DRUGS ON THE TRIPLICATE PRESCRIPTION PROGRAM:
NOTE: Trade names are included as examples only. Any brands or dosage forms of products
within a particular category are subject to the program. The list is subject to change from time to
time. Prescribers and pharmacists will be advised directly of the effective date of any additions or
deletions. Questions should be directed to the College of Physicians & Surgeons at (306) 244-8778,
or to the Saskatchewan Pharmaceutical Association at (306) 584-2292.
THE TRIPLICATE PRESCRIPTION PROGRAM PANEL OF DRUGS
(by product categories with examples)
ACETAMINOPHEN WITH CODEINE-in all dosage forms except
those containing 8mg or less of codeine (for example*)
Atasol 15, 30
Empracet 30, 60
Emtec-30
Exdol 15, 30
Lenoltec with Codeine #2, #3, #4
Novogesic C-15, C-30
Tylenol with Codeine #2, #3, #4
Tylenol with Codeine Elixir
HYDROCODONE-DIHYDROCODEINONE-continued
Robidone
Triaminic Expectorant DH
Tussaminic DH Forte
Tussaminic DH Pediatric
Tussionex Suspension, Tablets
HYDROMORPHONE-DIHYDROMORPHINONE-in all dosage
forms (for example*)
Dilaudid, all strengths
Dilaudid HP Parenteral
Hydromorphone, all strengths
ACETYLSALICYLIC ACID (ASA) WITH CODEINE- in all
dosage forms except those containing 8mg of codeine (for
example*)
282, 292, 293
Anacasal 15, 30
Phenaphen #2, #3, #4
282 Meps
Robaxisal C¼, C½
LEVORPHANOL-in all dosage forms (for example*)
Levo-Dromoran
MEPERIDINE-PETHIDINE-in all dosage forms (for example*)
Demerol Injectable, Tablets
Meperidine HCl Injectable
ANILERIDINE-in all dosage forms (for example*)
Leritine
METHADONE-in all dosage forms
METHYLPHENIDATE-in all dosage forms (for example*)
Ritalin
Ritalin SR
BUTALBITAL-in all dosage forms (for example*)
Fiorinal Plain
Tecnal
MORPHINE- in all dosage forms (for example*)
M.O.S., all strengths
Morphine Injectable
Morphine HP
Morphine LP
Morphitec, all strengths
MS Contin, all strengths
MSIR, all strengths
Oramorph SR, all strengths
Statex, all strengths
BUTALBITAL WITH CODEINE-in all dosage forms (for
example*)
Fiorinal C¼, C½
Tecnal C¼, C½
BUTORPHANOL
Stadol Nasal Spray
COCAINE-in all dosage forms
CODEINE- as the single active ingredient, or in combination with
other active ingredients in all dosage forms except those
containing 20mg per 30mL or less of codeine in liquid for oral
administration (for example*)
Codeine Tablets, all strengths
Codeine Syrup, all strengths
Codeine Injectable, all strengths
Co-Actifed Syrup, Tablets
CoSudafed Syrup, Tablets
CoSudafed Expectorant
Cotridine
Novahistex C
Omni-Tuss
Pentuss
Robitussin AC
Tussaminic C Forte and C Pediatric
NORMETHADONE-P-HYDROXYEPHEDRINE-in all dosage
forms (for example*)
Cophylac
Cophylac Expectorant
DEXTROAMPHETAMINE-in all dosage forms (for example*)
Dexedrine
PANTOPON-in all dosage forms
DIETHYLPROPION-in all dosage forms (for example*)
Tenuate
Tenuate Dospan
FENTANYL-transdermal system (for example*)
Duragesic, all strengths
HYDROCODONE-DIHYDROCODEINONE-in all dosage forms
(for example*)
Dimetane Expectorant-C
Hycodan Syrup, Tablets
Hycomine Syrup
Hycomine-S Pediatric Syrup
Mercodol with Decapryn
Novahistex DH
Novahistex DH Expectorant
Novahistine DH
OXYCODONE-as a single active ingredient, or in combination
with other active ingredients in all dosage forms (for example*)
Endocet
Endodan
Oxycocet
Ocyocodan
Oxycontin, all strengths
Percocet
Percocet-Demi
Percodan
Percodan-Demi
PENTAZOCINE-in all dosage forms (for example*)
Talwin
Talwin Compound-50
PHENTERMINE-in all dosage forms (for example*)
Fastin
Ionamin
PROPOXYPHENE-in all dosage forms (for example*)
642, 692
Darvon-N
Darvon-N Compound
Darvon-N with ASA
Novo-Proxyphene
Novo-Proxyphene Compound
*DISCLAIMER-The product names listed with each drug
category are for example only, and are not intended to be
inclusive.
308
APPENDIX G
CODES FOR PHARMACY ON-LINE CLAIMS PROCESSING
The following is a list of error and warning codes that may appear when processing
claims on the on-line system. The error codes are highlighted.
CODE
DESCRIPTION
AA
AI
AR
CA
CB
CC
CD
CE
CF
CO
CP
CR
CS
CT
FC
GA
GB
GC
GE
GG
GH
GI
GJ
GK
GL
GM
GN
GO
GP
GQ
GR
GT
GU
GW
GX
GY
GZ
HA
HB
HSN not on file
Registered Indian
HSN no coverage
Prescription number required
Prescriber ineligible
Prescriber required
Prescriber inactive
Prescriber not on file
Prescriber inactive
Pharmacy not on file
Dispensing date no contract
Dispensing date over 62 days
Dispensing date invalid
Invalid prescription number
Formulary Clearance
Possible duplicate same pharmacy
Possible duplicate same pharmacy
Verify quantity & unit cost
Unit drug cost exceeded
Non-formulary drug cost exceeded
Non-formulary drug cost exceeded
Dispense SOC for payment
Verify quantity & unit cost & possible duplicate
Total prescription cost exceeded(memory claim)
Patient paid exceeded(memory claim)
Verify quantity & possible duplicate
Verify unit cost & possible duplicate
Dispensing fee exceeds maximum
Possible duplicate different pharmacy
Possible duplicate different pharmacy
Age inconsistent with drug
Total prescription cost invalid(memory claim)
Patient paid invalid(memory claim)
Verify compound unit cost and compound fee
Compound quantity must be 1
Verify compound unit cost
Verify compound fee
Non-benefit DIN
DIN not on file
309
CODE
DESCRIPTION
HC
HD
HE
HF
HG
HH
HI
HJ
IP
IS
IT
MA
MB
NA
RC
RD
RE
SA
SF
TA
TB
TC
TD
TE
TF
TG
TH
TJ
TK
TL
TM
TN
TP
TQ
YI
YK
YL
YM
Three month supply exceeded
Three month supply exceeded; another pharmacy
Possible benefit under Exception Drug Status
Three submissions exceeded for Palliative Care
Three submissions exceeded for Palliative Care; another pharmacy
Verify quantity & three submissions exceeded for Palliative Care
Verify unit cost & three submissions exceeded for Palliative Care
Verify quantity & unit cost & three submissions exceeded for Palliative Care
Alternative Reimbursement not allowed
Alternative Reimbursement Fee exceeds maximum allowable
Alternative Reimbursement Type (Quantity) invalid
Mark-up percentage exceeds the maximum allowable
Discount percentage exceeds 100% (PC interfaced)
Transmission error - re-send
Void - original claim not found
Void - original claim already voided
Void not allowed - claim paid to family
Not authorized for PC interface - contact the Drug Plan Help Desk
File error - contact the Drug Plan Help Desk
Trial/Remainder/Alternative Reimbursement prior to April 1, 1996
Product not eligible for Trial Prescription Program
Trial not allowed - not a new medication
Trial not allowed - not a new medication; another pharmacy
Duplicate Trial prescription same pharmacy
Duplicate Trial prescription different pharmacy
Remainder not allowed - trial not found
Duplicate Remainder prescription same pharmacy
Remainder not allowed - dispensed too soon after trial
Remainder not allowed - regular prescription found same pharmacy
Remainder not allowed - regular prescription found different pharmacy
Dispensing Fee not allowed on Remainder
Regular prescription not allowed - trial found
Alternative Reimbursement not allowed - trial not found
Duplicate Alternative Reimbursement
Quantity exceeds maximum
Quantity exceeds the recommended quantity
Quantity exceeds the authorized limit
Quantity lower than minimum
310
APPENDIX H
MAINTENANCE DRUG SCHEDULE
The following lists of drugs are appended to the contract between Saskatchewan Health
and each Saskatchewan pharmacy. Prescribing and dispensing should be in these
quantities once the medical therapy of a patient is in the maintenance stage, unless there
are unusual circumstances that require these quantities not be dispensed.
100 DAY LIST (by product categories)
DIGITALIS PREPARATIONS
digoxin
PHENOBARBITAL
phenobarbital
ANTICONVULSANTS
carbamazepine
clobazam
clonazepam
divalproex sodium
ethosuximide
gabapentin
lamotrigine
methsuximide
nitrazepam
phenytoin
primidone
topiramate
valproate sodium
valproic acid
vigabatrin
ORAL HYPOGLYCEMICS
acarbose
chlorpropamide
glyburide
metformin
pioglitazone HCl
rosiglitazone maleate
repaglinide
tolbutamide
THYROID PREPARATIONS
thyroid
levothyroxine (sodium)
ANTI-THYROIDS
methimazole
propylthiouracil
TWO MONTH DRUG LIST (by product categories)
ORAL CONTRACEPTIVES
ESTROGENS
conjugated estrogens
estradiol
estropipate
ethinyl estradiol
piperazine estrone sulfate
stilboestrol
stilboestrol sodium diphosphate
311
APPENDIX I
TRIAL PRESCRIPTION PROGRAM MEDICATION LIST
A trial prescription provides a patient with a 7 or 10 day supply of new medication to
determine if it will be tolerated.
The following list of drugs is appended to the contract between Saskatchewan Health and
each Saskatchewan pharmacy. These medications are eligible for reimbursement under
the Trial Prescription Program.
ALPHA ADRENERGIC BLOCKERS
doxazosin
prazosin
terazosin
ANTIDEPRESSANT AGENTS
fluoxetine
fluvoxamine
moclobemide
nefazodone
paroxetine
sertraline
ANTILIPEMIC AGENTS
cholestyramine
colestipol
gemfibrozil
CALCIUM CHANNEL BLOCKERS
amlodipine
diltiazem
felodipine
nifedipine
verapamil
GASTROINTESTINAL AGENTS
misoprostol
HEMORRHELOGIC AGENTS
pentoxifylline
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
diclofenac
diclofenac/misoprostol
flurbiprofen
indomethacin
ketoprofen
piroxicam
sulindac
tiaprofenic acid
tolmetin
312
APPENDIX J
SASKATCHEWAN MS DRUGS PROGRAM
CRITERIA FOR COVERAGE OF MS DRUGS
Approval for coverage will be given to patients who are assessed and meet the following
criteria:
•
have clinical definite relapsing and remitting multiple sclerosis;
•
have had at least two attacks of MS during the previous two years (an attack is
defined as the appearance of new symptoms or worsening of old symptoms, lasting
at least 24 hours in the absence of fever, preceded by stability for at least one
month);
•
are fully ambulatory 100 meters without aids (canes, walkers or wheelchairs)Extended Disability Status Scale (EDSS) 5.5 or less;
•
are age 18 or older.
Contraindications to Treatment
•
concurrent illness likely to alter compliance or substantially reduce life expectancy;
•
pregnancy is planned or occurs;
•
nursing women;
•
active, severe depression.
Physicians should also forward the following information:
•
documentation of attacks, date of onset, date of diagnosis;
•
neurological findings, Extended Disability Status Scale (EDSS)-if known;
•
MRI reports or other significant information;
•
list of current medications.
PROCEDURE FOR OBTAINING COVERAGE OF MS DRUGS UNDER DRUG PLAN
•
Requests are initiated by a physician. The patient and physician complete the
application form and the physician forwards any relevant information to the
Saskatchewan MS Drugs Program. A copy of the application form appears in this
appendix.
•
The MS Drug Advisory Panel reviews the application form and relevant
documentation and renders a decision. Note: A patient's eligibility for coverage
is determined by the MS Drug Advisory Panel. The Drug Plan is notified of the
decision and communicates the results to the patient and the physician.
•
Questions regarding eligibility should be directed to:
Saskatchewan MS Drugs Program
Suite 7703-7th Floor
Saskatoon City Hospital
Saskatoon, S7K 0M7
Telephone: (306) 655-8400
FAX:
(306) 655-8404
•
Upon approval of coverage, patients are encouraged to apply for assistance with
the cost of these medications under the Drug Plan Special Support Program. For
more detailed information regarding this program, see Appendix E.
313
MS DRUG APPROVAL PROCESS
Fax #: (306) 655-8404
Physician
EDS
Application
(Patient consent)
MS Drug
Advisory
Panel
Not
Approved
Approved
Patient
Education
Schedule
Response to
Physician
&
Patient
Drug Plan
On-line Update
Physician
Letter
(Special Support Approval)
Patient
Letter
Follow-up
On-going
Assessment
MS Drug
Advisory
Panel
314
Saskatchewan
Health
Drug Plan &
Extended Benefits
Branch
MS DRUGS EXCEPTION DRUG STATUS APPLICATION
DATE: ___________________________
NAME: _______________________________________________ B/D: ______________________
(D/M/Y)
ADDRESS: _______________________________________________________________________
______________________________________________________ PHONE: __________________
NEUROLOGIST: __________________________________________________________________
DATE OF LAST CONSULTATION: ______________________
FAMILY PHYSICIAN: __________________________________ HSN: ____________________
Drug Requested:
Rebif
Avonex
Betaseron
Copaxone
Exception Drug Status approval will be given to patients who are assessed and meet the following
criteria:
Yes
No
1. Have clinical definite relapsing and remitting multiple sclerosis
2. Have had at least two attacks of MS during the previous two
years (an attack is defined as the appearance of new symptoms
or worsening of old symptoms, lasting at least 24 hours in the
absence of fever, preceded by stability for at least one month)
3. Are fully ambulatory 100 meters without aids (canes, walkers
or wheelchairs) – EDSS 5.5 or less
4. Are age 18 or older
Contraindications to Treatment
1. Concurrent illness likely to alter compliance or substantially
reduce life expectancy
2. Pregnancy is planned or occurs, nursing women
3. Active, severe depression
I, (patient signature) ____________________________________________, give my permission for any
health care provider involved in my care to release to the Advisory Panel any information that may be deemed
necessary in assessing my application for coverage and subsequent monitoring.
MD Signature: ___________________________ Address: ____________________________________
Telephone: ______________________________ Fax: _________________________________
Please Forward:
- clinical history including:
a) documentation of attacks, date of onset, date of diagnosis
b) neurological findings, Extended Disability Status Scale (EDSS) - if known
c) MRI reports or other significant information
d) list current medications
Mail to:
Saskatchewan MS Drugs Program
Suite 7703 - 7th Floor
Saskatoon City Hospital
SASKATOON, Saskatchewan S7K 0M7
OR
Fax:
(306) 655-8404
For clinical program information: Phone (306) 655-8400 For reimbursement information: Phone 1-800-667-7578.
315
INDICES
INDEX A - PHARMACEUTICAL MANUFACTURERS LIST
INDEX B - THERAPEUTIC CLASSIFICATION LIST
INDEX C - NUMERICAL LIST OF DRUG IDENTIFICATION
NUMBERS
INDEX D - ALPHABETICAL LIST OF PHARMACEUTICAL
PRODUCT NAMES
INDEX A
PHARMACEUTICAL MANUFACTURERS LIST
ABB
ACT
AGR
AKN
ALC
ALL
ALX
AMG
APX
AST
AVT
AXC
BAY
BCD
BEX
BGN
BMI
BMY
BOE
BOM
BRI
BVL
CCL
CDX
CLC
COB
CYT
DBU
DER
DOM
DPY
DUI
FEI
FFR
FUJ
GAC
GCH
GLW
GPM
GSK
GZY
HDI
HLR
HOR
ICN
JAN
KEY
LEA
LEO
LIH
LIL
Abbott Laboratories Ltd.
Actelion Pharmaceutiques Canada
Agouron Pharmaceuticals Canada Inc.
Dioptic Laboratories, Division of Akorn Pharmaceuticals Canada Ltd.
Alcon Canada Inc.
Allergan Inc.
Allerex Laboratory Ltd.
Amgen Canada Inc.
Apotex Inc.
AstraZeneca
Aventis Pharma Inc.
Axcan Pharma
Bayer Inc.-Healthcare Division
Bayer Inc.-Consumer Care Division
Berlex Canada Inc.
Biogen Canada Inc.
Bioenhance Medicines Inc.
Bristol-Myers Squibb Canada Inc.
Boehringer Ingelheim (Canada) Ltd.
Roche Diagnostics, Division of Hoffmann-LaRoche Limited
Bristol Pharmaceutical Products - Bristol-Myers Squibb
Biovail Pharmaceuticals
Chiron Canada Ltd.
Canderm Pharma Inc.
Columbia Laboratories Canada Inc.
Cobalt Pharmaceuticals Inc.
Cytex Pharmaceuticals Inc.
Faulding (Canada) Inc.
Dermik Laboratories Canada Inc.
Dominion Pharmacal
Draxis Health Inc.
Duchesnay Inc.
Ferring Inc.
Fournier Pharma Inc.
Fujisawa Canada Inc.
Galderma Canada Inc.
GlaxoSmithKline Consumer Healthcare Inc.
Glenwood Laboratories Canada Ltd.
Genpharm Inc.
GlaxoSmithKline
Genzyme Canada Inc.
Hill Dermaceuticals, Inc.
Hoffmann-LaRoche Ltd.
Carter-Horner Inc.
ICN Canada Ltd.
Janssen-Ortho Inc.
Key, Division of Schering Canada Inc.
Lee-Adams Laboratories, Division of Pharmascience Inc.
Leo Pharma Inc.
Lioh Inc.
Eli Lilly Canada Inc.
318
LIN
LSN
LUD
MCL
MDA
MDC
MDS
MED
MSD
NOO
NOP
NVO
NVR
NXP
ODN
OPT
ORG
ORP
PAL
PFC
PFI
PFR
PGA
PHU
PML
PMS
PNG
PPZ
PRO
RBP
RHO
RIV
ROG
ROP
RTP
SAB
SAW
SCH
SCP
SEV
SLV
SQU
SRO
STI
TAR
THM
THR
THS
TVM
VIR
VTH
WEL
WSD
WYA
ZYP
Linson Pharma Inc.
Lifescan Canada Ltd.
Lundbeck Canada Inc
McNeil Consumer Healthcare
3M Pharmaceuticals, 3M Canada Company
Medicis Canada Ltd.
Medisense Canada Inc.
Medican Pharma Inc.
Merck Frosst Canada Ltd.
Novo Nordisk Canada Inc.
Novopharm Ltd.
Novartis Ophthalmics, Novartis Pharmaceuticals Canada Inc.
Novartis Pharmaceuticals Canada Inc.
Nu-Pharm Inc.
Odan Laboratories Limited
OptimaPharma, Division of Taro Pharmaceuticals Inc.
Organon Canada Ltd.
Orphan Medical Inc.
Paladin Labs Inc.
Pfizer Canada Inc.-Consumer Health Care Division
Pfizer Canada Inc.
Purdue Pharma
Procter & Gamble Pharm. Canada, Inc.
Pharmacia Canada Inc.
PharmMel Inc.
Pharmascience Inc.
PanGeo Pharma Inc.
Princeton Pharmaceutical Products - Bristol-Myers Squibb
Proval Pharma Inc.
Shire Canada Inc.
Rhoxalpharma Inc.
Riva Laboratories Ltd.
Rougier Pharma Inc., Division of Technilab
Rhodiapharm
Ratiopharm Inc.
Sabex 2002 Inc.
Sanofi-Synthelabo Canada Inc.
Schering Canada Inc.
Schering-Plough Healthcare Products
Servier Canada Inc.
Solvay Pharma Inc.
Squibb Pharmaceutical Products - Bristol-Myers Squibb
Serono Canada Inc.
Stiefel Canada Inc.
Taro Pharmaceuticals Inc.
Theramed Corporation
Thermor Ltd.
Therasense Canada
Teva Marion Partners Canada
Virco Pharmaceuticals (Canada), Inc.
Vita Health Products
Wellspring Pharmaceutical Canada Corp.
Westwood Squibb Canada
Wyeth-Ayerst Inc.
Zymcan Pharmaceuticals Inc.
319
INDEX B
THERAPEUTIC CLASSIFICATION LIST
08:00 ANTI-INFECTIVE AGENTS................................................................................................... .
08:04.00 AMEBICIDES................................................................................................................ .
08:08.00 ANTHELMINTICS......................................................................................................... .
08:12.00 ANTIBIOTICS................................................................................................................ .
08:12.02 ANTIBIOTICS (AMINOGLYCOSIDES)......................................................................... .
08:12.04 ANTIBIOTICS (ANTIFUNGALS)................................................................................... .
08:12.06 ANTIBIOTICS (CEPHALOSPORINS)........................................................................... .
08:12.12 ANTIBIOTICS (MACROLIDES)..................................................................................... .
08:12.16 ANTIBIOTICS (PENICILLINS)...................................................................................... .
08:12.24 ANTIBIOTICS (TETRACYCLINES)............................................................................... .
08:12.28 ANTIBIOTICS (MISCELLANEOUS ANTIBIOTICS)...................................................... .
08:18.00 ANTIVIRALS................................................................................................................. .
08:18.08 ANTIRETROVIRAL AGENTS (NONNUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS)....................................................................... .
TRANSCRIPTASE INHIBITORS)....................................................................... .
08:18.08 ANTIRETROVIRAL AGENTS (PROTEASE INHIBITORS)........................................... .
08:20.00 ANTIMALARIAL AGENTS............................................................................................. .
08:22.00 QUINOLONES.............................................................................................................. .
08:36.00 URINARY ANTI-INFECTIVES....................................................................................... .
08:40.00 MISCELLANEOUS ANTI-INFECTIVES........................................................................ .
10:00 ANTINEOPLASTIC AGENTS................................................................................................ .
10:00.00 ANTINEOPLASTIC AGENTS........................................................................................ .
12:00 AUTONOMIC DRUGS........................................................................................................... .
12:04.00 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS............................................. .
12:08.04 ANTIPARKINSONIAN AGENTS................................................................................... .
12:08.08 ANTIMUSCARINICS/ANTISPASMODICS.................................................................... .
12:12.00 SYMPATHOMIMETIC (ADRENERGIC) AGENTS........................................................ .
12:16.00 SYMPATHOLYTIC AGENTS (ANTIMIGRAINE DRUGS)............................................. .
12:20.00 SKELETAL MUSCLE RELAXANTS.............................................................................. .
20:00 BLOOD FORMATION AND COAGULATION....................................................................... .
20:04.04 IRON PREPARATIONS................................................................................................ .
20:12.04 ANTICOAGULANTS..................................................................................................... .
20:12.20 ANTIPLATELET DRUGS.............................................................................................. .
20:16.00 HEMATOPOIETIC AGENTS......................................................................................... .
20:24.00 HEMORRHEOLOGIC AGENTS.................................................................................... .
24:00 CARDIOVASCULAR DRUGS............................................................................................... .
24:04.00 CARDIAC DRUGS........................................................................................................ .
24:06.00 ANTILIPEMIC DRUGS.................................................................................................. .
24:08.00 HYPOTENSIVE DRUGS............................................................................................... .
24:12.00 VASODILATING DRUGS.............................................................................................. .
28:00 CENTRAL NERVOUS SYSTEM DRUGS............................................................................. .
28:08.04 NON-STEROIDAL ANTI-INFLAMMATORY AGENTS.................................................. .
28:08.08 OPIATE AGONISTS (NARCOTIC ANALGESICS)....................................................... .
28:08.12 OPIATE PARTIAL AGONISTS...................................................................................... .
28:08.92 MISCELLANEOUS ANALGESICS AND ANTIPYRETICS............................................ .
28:12.04 ANTICONVULSANTS (BARBITURATES).................................................................... .
28:12.08 ANTICONVULSANTS (BENZODIAZEPINES).............................................................. .
28:12.12 ANTICONVULSANTS (HYDANTOINS)........................................................................ .
28:12.20 ANTICONVULSANTS (SUCCINIMIDES)...................................................................... .
28:12.92 MISCELLANEOUS ANTICONVULSANTS.................................................................... .
28:16.04 PSYCHOTHERAPEUTIC AGENTS (ANTIDEPRESSANTS)........................................ .
28:16.08 PSYCHOTHERAPEUTIC AGENTS (ANTIPSYCHOTIC AGENTS).............................. .
28:20.00 RESPIRATORY AND CEREBRAL STIMULANTS........................................................ .
28:24.04 ANXIOLYTICS,SEDATIVES AND HYPNOTICS (BARBITURATES)............................ .
28:24.08 ANXIOLYTICS,SEDATIVES AND HYPNOTICS (BENZODIAZEPINES)...................... .
28:24.92 MISCELLANEOUS ANXIOLYTICS,SEDATIVES AND HYPNOTICS........................... .
28:28.00 ANTIMANIC AGENTS................................................................................................... .
36:00 DIAGNOSTIC AGENTS......................................................................................................... .
36:04.00 ADRENAL INSUFFICIENCY......................................................................................... .
36:26.00 DIABETES MELLITUS.................................................................................................. .
36:88.00 URINE CONTENTS...................................................................................................... .
320
2
2
2
2
3
3
5
7
8
11
12
13
15
15
17
18
19
20
21
24
24
28
28
28
29
30
34
36
40
40
40
42
42
42
46
46
56
58
71
76
76
82
89
89
89
90
91
91
91
95
104
111
112
112
116
117
120
120
120
121
40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE........................................................ .
40:12.00 REPLACEMENT AGENTS............................................................................................ .
40:18.00 POTASSIUM-REMOVING RESINS.............................................................................. .
40:28.00 DIURETICS................................................................................................................... .
40:28.10 POTASSIUM SPARING DIURETICS............................................................................ .
40:40.00 URICOSURIC DRUGS.................................................................................................. .
48:00 COUGH PREPARATIONS.................................................................................................... .
48:24.00 MUCOLYTIC AGENTS................................................................................................. .
52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS............................................................ .
52:04.04 ANTI-INFECTIVES (ANTIBIOTICS).............................................................................. .
52:04.06 ANTI-INFECTIVES (ANTIVIRALS)............................................................................... .
52:04.08 ANTI-INFECTIVES (SULFONAMIDES)........................................................................ .
52:04.12 ANTI-INFECTIVES (MISCELLANEOUS)...................................................................... .
52:08.00 ANTI-INFLAMMATORY AGENTS................................................................................. .
52:08.00 COMBINATION ANTI-INFECTIVE/ ANTI-INFLAMMATORY AGENTS........................ .
52:10.00 CARBONIC ANHYDRASE INHIBITORS...................................................................... .
52:20.00 MIOTICS....................................................................................................................... .
52:24.00 MYDRIATICS................................................................................................................ .
52:36.00 MISCELLANEOUS E.E.N.T. DRUGS........................................................................... .
56:00 GASTROINTESTINAL DRUGS............................................................................................. .
56:08.00 ANTIDIARRHEA AGENTS............................................................................................ .
56:12.00 CATHARTICS AND LAXATIVES.................................................................................. .
56:16.00 DIGESTANTS............................................................................................................... .
56:22.00 ANTI-EMETICS............................................................................................................. .
56:40.00 MISCELLANEOUS GASTROINTESTINAL DRUGS..................................................... .
60:00 GOLD COMPOUNDS............................................................................................................ .
60:00.00 GOLD COMPOUNDS................................................................................................... .
64:00 METAL ANTAGONISTS........................................................................................................ .
64:00.00 METAL ANTAGONISTS................................................................................................ .
68:00 HORMONES AND SUBSTITUTES....................................................................................... .
68:04.00 ADRENAL CORTICOSTEROIDS................................................................................. .
68:08.00 ANDROGENS............................................................................................................... .
68:12.00 CONTRACEPTIVES..................................................................................................... .
68:16.00 ESTROGENS................................................................................................................ .
68:16.12 ESTROGEN AGONIST-ANTAGONISTS...................................................................... .
68:18.00 GONADOTROPINS...................................................................................................... .
68:20.08 ANTI-DIABETIC DRUGS (INSULINS-PORK)............................................................... .
68:20.08 ANTI-DIABETIC DRUGS (INSULINS-HUMAN BIOSYNTHETIC)................................ .
68:20.20 ANTI-DIABETIC DRUGS (ORAL HYPOGLYCEMICS)................................................. .
68:24.00 PARATHYROID............................................................................................................ .
68:28.00 PITUITARY AGENTS.................................................................................................... .
68:32.00 PROGESTINS............................................................................................................... .
68:36.04 THYROID AGENTS...................................................................................................... .
68:36.08 ANTITHYROID AGENTS.............................................................................................. .
84:00 SKIN AND MUCOUS MEMBRANE PREPARATIONS......................................................... .
84:04.04 ANTI-INFECTIVES (ANTIBIOTICS).............................................................................. .
84:04.08 ANTI-INFECTIVES (ANTI-FUNGALS).......................................................................... .
84:04.12 ANTI-INFECTIVES (SCABICIDES AND PEDICULICIDES)......................................... .
84:04.16 MISCELLANEOUS ANTI-INFECTIVES........................................................................ .
84:06.00 ANTI-INFLAMMATORY AGENTS................................................................................. .
84:06.00 COMBINATION ANTI-INFECTIVE/ ANTI-INFLAMMATORY AGENTS........................ .
84:08.00 ANTIPRURITICS AND LOCAL ANAESTHETICS......................................................... .
84:12.00 ASTRINGENTS............................................................................................................. .
84:16.00 CELL STIMULANTS AND PROLIFERANTS................................................................ .
84:28.00 KERATOLYTIC AGENTS.............................................................................................. .
84:36.00 MISCELLANEOUS SKIN & MUCOUS MEMBRANE AGENTS.................................... .
84:50.06 DEPIGMENTING & PIGMENTING AGENTS (PIGMENTING AGENTS)...................... .
86:00 SMOOTH MUSCLE RELAXANTS........................................................................................ .
86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS................................................. .
86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS..................................................... .
88:00 VITAMINS.............................................................................................................................. .
88:04.00 VITAMIN A.................................................................................................................... .
88:08.00 VITAMINS B.................................................................................................................. .
88:16.00 VITAMIN D.................................................................................................................... .
92:00 UNCLASSIFIED THERAPEUTIC AGENTS.......................................................................... .
92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS.................................................................. .
321
124
124
124
126
126
127
130
130
132
132
133
133
133
134
136
137
138
138
139
144
144
144
145
146
147
154
154
156
156
158
158
162
163
166
168
168
168
169
171
173
173
175
176
177
180
180
181
183
184
184
195
196
196
196
198
199
200
202
202
202
206
206
206
207
210
210
INDEX C
NUMERICAL LIST OF DRUG IDENTIFICATION NUMBERS
DIN
00000086
00000299
00000655
00000663
00000779
00000787
00000841
00000868
00000884
00004405
00004588
00004596
00004723
00004758
00004774
00005525
00005533
00005541
00005606
00005614
00009830
00010081
00010200
00010219
00010332
00010340
00010383
00010391
00010405
00010472
00010480
00012696
00012718
00013285
00013579
00013595
00013609
00013765
00013773
00013803
00015148
00015156
00015229
00015237
00015288
00015377
00015423
00015741
00016055
00016128
00016233
00016322
00016330
00016349
00016357
00016438
00016446
00016497
00016500
00020877
00020885
00021008
00021016
PAGE
112
8
138
138
139
139
138
138
138
29
210
210
25
29
19
63
63
63
111
111
207
88
177
177
76
76
40
40
92
99
99
114
114
114
146
146
146
114
114
146
112
112
101
101
112
213
13
177
156
28
79
95
95
95
28
159
159
125
125
10
10
19
19
DIN
PAGE
00021067
00021075
00021172
00021202
00021261
00021350
00021423
00021474
00021482
00021555
00021695
00022608
00022772
00022780
00022799
00022802
00023442
00023450
00023485
00023698
00023949
00023957
00023965
00024325
00024333
00024341
00024368
00024430
00024449
00024457
00024694
00026034
00026050
00026093
00027243
00027499
00027898
00027901
00027944
00028053
00028096
00028274
00028282
00028339
00028355
00028363
00028606
00029092
00029173
00029238
00029246
00030570
00030600
00030619
00030759
00030767
00030783
00030848
00030910
00030929
00030937
00030988
00035017
322
206
206
7
10
18
171
146
125
125
21
161
165
91
91
91
91
91
91
91
91
176
176
176
97
97
97
11
110
110
110
116
184
184
184
34
34
190
190
190
133
159
3
3
132
190
190
126
182
105
167
162
12
161
161
161
161
162
175
161
161
175
161
138
DIN
00035092
00035106
00035122
00035130
00035149
00036129
00036323
00037605
00037613
00037621
00042560
00042579
00042676
00067385
00067393
00074225
00074454
00125083
00125105
00125121
00155225
00155357
00176214
00178799
00178802
00178810
00178829
00180408
00187585
00192597
00192600
00216666
00220442
00223824
00225851
00228079
00228087
00229296
00230197
00230316
00232157
00232378
00232475
00232807
00232823
00232831
00236683
00247855
00248169
00249580
00249920
00252522
00252654
00253952
00259527
00261238
00261432
00262595
00263699
00263818
00265470
00265489
00268585
PAGE
121
121
121
121
121
161
144
165
73
73
134
134
137
71
71
124
136
84
85
84
79
31
34
89
89
89
89
68
198
193
194
76
146
3
13
193
193
76
146
194
104
161
206
104
104
104
117
135
4
54
31
133
200
173
61
219
88
7
198
145
166
166
206
DIN
00268593
00268607
00268631
00270636
00270644
00271373
00271489
00280437
00285455
00285471
00291889
00293504
00293512
00294322
00294837
00294926
00294950
00295094
00295973
00297143
00299405
00301175
00306290
00307246
00312711
00312738
00312746
00312754
00312762
00312770
00312789
00312797
00312800
00313815
00313823
00315966
00317047
00319511
00323071
00324019
00326836
00326844
00326852
00326925
00327794
00328219
00329320
00330566
00330582
00335053
00335061
00335088
00335096
00335118
00335126
00335134
00337420
00337439
00337730
00337749
00337757
00337765
00337773
00340731
00342084
00342092
00342106
00342114
PAGE
206
206
207
21
22
161
196
159
126
160
61
82
82
210
30
127
206
160
182
164
135
135
29
137
171
20
110
110
173
161
81
99
125
108
108
164
164
20
189
96
110
125
99
97
78
215
34
96
200
95
95
95
108
108
108
108
78
79
125
125
10
10
10
164
6
6
6
6
DIN
PAGE
00343838
00344923
00345504
00345539
00349739
00349917
00353027
00355658
00358177
00360198
00360201
00360228
00360236
00360244
00360252
00360260
00360279
00360287
00361933
00362158
00362166
00363650
00363669
00363677
00363685
00363693
00363766
00363812
00364142
00364282
00368040
00369810
00370568
00371033
00372838
00372846
00373036
00374318
00374407
00382825
00382841
00386391
00386464
00386472
00392537
00392561
00392588
00396761
00396788
00396796
00396818
00396826
00396834
00397423
00397431
00399302
00399310
00400750
00402516
00402540
00402575
00402583
00402591
00402605
00402680
00402699
00402737
00402745
323
164
189
77
110
28
105
164
215
137
110
99
110
110
110
65
65
125
125
29
114
125
106
106
106
106
210
146
29
78
210
22
91
198
211
164
164
198
198
159
90
90
25
215
215
146
87
87
89
125
106
106
106
106
50
51
171
89
97
174
51
66
66
96
50
115
92
115
115
DIN
00402753
00402761
00402788
00402796
00402818
00403571
00405329
00405337
00405345
00405361
00406716
00406724
00406848
00410632
00417246
00417270
00417289
00426830
00426849
00426857
00430617
00432938
00436771
00441619
00441627
00441635
00441651
00441686
00441694
00441708
00441716
00441724
00441732
00441740
00441759
00441767
00441775
00443158
00443174
00443794
00443816
00443832
00443840
00445126
00445266
00445274
00445282
00451207
00452092
00452130
00452149
00453617
00454583
00455881
00458686
00458694
00460990
00461008
00461733
00463256
00463698
00464880
00465208
00465216
00469327
00471526
00474517
00474525
PAGE
54
54
54
210
210
198
114
114
105
105
8
8
198
105
189
52
53
65
206
28
183
198
132
63
63
63
78
72
72
65
65
203
203
54
127
127
70
115
53
197
197
94
94
151
22
21
22
141
71
9
9
8
196
36
72
72
203
203
117
51
106
56
5
5
163
163
207
207
DIN
00476366
00476552
00476714
00476722
00479799
00481211
00481815
00481823
00483923
00484911
00486582
00487805
00487813
00487872
00489158
00496480
00496499
00496502
00497452
00497479
00497827
00497894
00499013
00500895
00502197
00502200
00502790
00503134
00503436
00504335
00506052
00506370
00507989
00509353
00509558
00510637
00510645
00511528
00511536
00511552
00511641
00511692
00512184
00512192
00513253
00513261
00513288
00513644
00513962
00513997
00514004
00514012
00514217
00514497
00514500
00514535
00514551
00518123
00518131
00518174
00518182
00519251
00521515
00521698
00521701
00522597
00522651
00522678
PAGE
203
101
196
196
210
124
207
207
55
78
87
126
59
147
160
54
54
54
85
85
51
156
20
219
194
193
145
194
203
54
78
210
94
69
30
21
22
90
90
34
156
203
132
132
194
193
193
169
133
215
76
76
87
66
66
169
168
113
113
197
197
61
206
114
114
215
80
80
DIN
PAGE
00522724
00522988
00522996
00523372
00525596
00525618
00527661
00529117
00532657
00534560
00534579
00534587
00535427
00535435
00536709
00537594
00537608
00541389
00545015
00545058
00545066
00545074
00545678
00546240
00546283
00546291
00546305
00548359
00548367
00548375
00550094
00550957
00552135
00552143
00552429
00554316
00554324
00555649
00556734
00556742
00560022
00560952
00560960
00560979
00564966
00565342
00565350
00566748
00566756
00568449
00568627
00568635
00568643
00572349
00575151
00575240
00576158
00577308
00578428
00578436
00578452
00578541
00578568
00578576
00578657
00579335
00579351
00579378
324
113
113
113
51
81
81
198
138
70
51
66
66
190
190
203
198
198
31
137
29
21
29
8
147
60
60
61
112
112
216
146
161
106
106
106
70
70
219
2
203
194
67
67
67
126
210
80
198
198
147
66
66
211
211
203
138
30
214
190
190
11
194
197
197
30
194
102
103
DIN
00579947
00580929
00582255
00582263
00582271
00582301
00582344
00582352
00582417
00582514
00583405
00583413
00583421
00584223
00584282
00584991
00585009
00585092
00585114
00586668
00586676
00586706
00586714
00587265
00587281
00587303
00587354
00587362
00587702
00587737
00587818
00587826
00587834
00587958
00587966
00589861
00590665
00590827
00591467
00591475
00592277
00593435
00593451
00594377
00594466
00594636
00594644
00594652
00595799
00595802
00596418
00596426
00596434
00596965
00598194
00598461
00598488
00599026
00599905
00600059
00600067
00600784
00600792
00600806
00602884
00602957
00602965
00603260
PAGE
196
12
54
54
54
180
200
200
147
105
21
6
6
72
147
111
111
175
78
180
180
136
169
28
166
166
29
29
106
169
192
192
192
197
197
80
117
77
87
87
80
83
83
68
79
85
85
85
193
194
92
92
93
87
161
151
151
57
203
147
147
214
78
80
124
164
164
10
DIN
00603279
00603287
00603295
00603678
00603686
00603708
00603716
00603821
00604453
00604461
00605859
00607126
00607142
00607762
00607770
00608882
00609129
00610267
00611158
00611166
00611174
00613215
00613223
00613231
00614254
00615315
00615323
00615331
00617288
00618284
00618292
00618632
00618640
00620955
00620963
00621374
00621463
00621935
00622133
00623377
00627097
00627100
00628115
00628123
00628131
00628158
00628190
00628204
00628212
00629332
00629340
00629359
00629367
00631701
00632201
00632228
00632481
00632503
00632600
00632716
00632724
00632732
00632775
00633836
00634506
00636576
00636622
00637661
PAGE
10
10
10
147
147
53
53
116
115
115
8
51
7
87
87
83
146
207
78
79
195
126
126
68
133
80
80
80
87
10
10
50
51
32
32
211
83
87
85
183
80
84
8
8
9
9
113
113
113
78
78
78
189
203
87
87
87
87
149
81
77
77
111
4
13
36
98
140
DIN
PAGE
00637742
00637750
00638676
00638684
00638692
00639389
00639885
00641154
00641790
00641863
00642215
00642223
00642886
00642894
00642975
00643025
00644633
00645575
00646016
00646024
00646059
00646148
00646237
00647942
00647969
00648035
00648043
00652318
00653209
00653217
00653241
00653268
00653276
00655740
00655759
00655767
00657182
00657204
00657212
00657298
00658855
00659606
00662348
00663719
00664227
00666122
00666203
00666246
00670901
00670928
00670944
00674222
00675199
00675229
00675962
00677477
00677485
00677590
00682020
00682217
00682314
00685925
00685933
00687200
00687219
00687456
00688622
00690198
325
114
114
53
53
53
88
53
194
150
197
10
10
81
81
56
20
10
89
116
116
116
169
200
78
106
50
51
8
190
190
82
180
82
114
114
114
68
197
11
62
51
57
197
54
160
180
180
196
62
62
72
133
78
21
86
112
112
21
7
136
113
151
151
82
82
133
189
85
DIN
00690201
00690228
00690244
00690783
00690791
00690805
00692689
00692697
00692700
00694371
00694398
00695351
00695440
00695459
00695661
00695696
00695718
00698059
00700401
00701904
00703486
00703591
00703605
00703974
00704423
00704431
00705438
00707503
00707600
00708879
00708917
00710113
00710121
00711101
00713325
00713333
00713341
00713376
00713449
00716618
00716626
00716634
00716642
00716650
00716685
00716693
00716782
00716790
00716812
00716820
00716839
00716863
00716871
00716898
00716901
00716952
00716960
00716987
00717002
00717029
00717495
00717509
00717568
00717576
00717584
00717592
00717606
00717630
PAGE
85
86
86
87
87
104
203
203
203
132
132
198
19
19
60
81
81
200
135
136
144
183
183
181
24
24
84
163
163
62
175
148
148
114
53
53
53
124
106
190
190
190
190
190
193
194
192
192
192
193
193
193
182
182
182
195
195
195
195
195
10
65
10
65
10
10
12
10
DIN
00717649
00717657
00717673
00720933
00720941
00722146
00725110
00725749
00725765
00726540
00728179
00728187
00728195
00728209
00728276
00728284
00729973
00731323
00731439
00733059
00733067
00733075
00738824
00738832
00738840
00739839
00740497
00740675
00740713
00740799
00740802
00740810
00740829
00741817
00742554
00743518
00745588
00745596
00745626
00749354
00750050
00751170
00751286
00751871
00755338
00755575
00755583
00755826
00755834
00755842
00755850
00755869
00755877
00755885
00755893
00755907
00756784
00756792
00756814
00756830
00756849
00756857
00759465
00759473
00759481
00759503
00761605
00761613
PAGE
10
10
10
171
171
13
52
85
85
22
202
114
114
114
125
125
175
25
30
150
150
170
116
116
116
134
40
54
11
103
103
103
103
116
71
104
82
82
174
50
190
51
140
110
124
105
92
141
141
55
55
55
52
53
53
52
135
167
81
52
167
167
63
63
63
106
103
103
DIN
PAGE
00761621
00761648
00761672
00761680
00766046
00768715
00768723
00769533
00769541
00769991
00771368
00771376
00771384
00773611
00773689
00773697
00775320
00776181
00776203
00776521
00778338
00778346
00778354
00778362
00778907
00778915
00779474
00782327
00782459
00782467
00782475
00782483
00782491
00782505
00782718
00782742
00783137
00784338
00784400
00785261
00786535
00786543
00786616
00788716
00789429
00789437
00789445
00789747
00790419
00790427
00792659
00792667
00792942
00795852
00795860
00795879
00800430
00805009
00807435
00808539
00808547
00808563
00808571
00808652
00808733
00808741
00809187
00812331
326
103
103
79
79
135
6
6
124
124
7
183
48
48
92
47
47
110
86
86
132
149
149
82
82
137
137
83
162
76
51
51
70
70
51
92
36
21
196
59
134
84
84
34
13
145
145
145
109
32
79
116
4
203
57
57
170
13
189
132
76
76
115
115
106
171
171
189
70
DIN
00812358
00812366
00812374
00812382
00813966
00816078
00817120
00818658
00818666
00818674
00818682
00821373
00824143
00824291
00824305
00828556
00828564
00828688
00828823
00832804
00836230
00836249
00836273
00836362
00839175
00839183
00839191
00839205
00839213
00839388
00839396
00839418
00842648
00842656
00842834
00846341
00846368
00846465
00849650
00849669
00850322
00850330
00851639
00851647
00851655
00851663
00851671
00851698
00851736
00851744
00851752
00851760
00851779
00851787
00851795
00851833
00851841
00851922
00851930
00852074
00852384
00854409
00855774
00856711
00860689
00860697
00860700
00860751
PAGE
70
181
181
181
149
207
11
69
69
69
69
145
174
207
174
150
150
150
150
5
81
81
214
174
76
76
216
216
216
64
64
64
50
51
148
34
215
22
189
189
87
87
60
60
61
51
51
51
194
194
159
159
63
63
62
60
32
57
57
159
72
144
154
194
113
113
113
11
DIN
00860808
00862924
00862932
00862975
00865397
00865400
00865532
00865540
00865559
00865567
00865575
00865591
00865605
00865613
00865621
00865648
00865656
00865664
00865672
00865680
00865699
00865710
00865729
00865737
00865745
00865753
00865761
00865788
00865818
00865826
00865834
00865850
00865869
00865877
00865885
00868949
00868957
00869007
00869015
00869023
00869945
00869953
00869961
00870013
00870021
00870935
00871095
00872318
00872334
00872423
00872431
00873292
00873454
00873993
00874086
00874256
00878790
00878928
00878936
00882801
00882828
00882836
00884324
00884332
00884340
00884359
00884413
00884421
PAGE
33
48
48
189
112
112
70
9
9
8
8
52
50
51
80
80
80
80
114
114
114
21
22
150
150
22
81
81
147
147
147
78
79
6
6
61
61
52
53
53
28
28
28
197
197
215
194
134
159
115
115
192
7
174
32
11
135
47
47
67
67
67
58
58
58
58
65
65
DIN
PAGE
00884502
00885401
00885428
00885436
00885444
00885835
00885843
00885851
00886009
00886017
00886025
00886033
00886041
00886068
00886076
00886106
00886114
00886122
00886130
00886149
00886432
00886440
00888354
00888400
00888524
00888532
00890960
00891800
00891819
00893560
00893595
00893609
00893617
00893625
00893749
00893757
00893773
00893781
00894710
00894729
00894737
00894745
00897272
00897310
00897329
00899356
00950068
00950238
00950300
00950378
00950408
00950432
00950459
00950505
00950572
00950734
00950792
00950793
00950807
00950815
00950823
00950831
00950878
00950882
00950883
00950889
00950893
00950894
327
214
84
84
84
84
59
59
59
53
76
76
70
70
48
48
59
47
47
53
52
108
108
139
126
48
48
56
3
3
140
60
60
60
61
58
58
141
141
183
183
104
104
55
197
197
100
120
121
120
120
120
120
120
120
120
120
199
199
199
199
199
120
120
120
120
120
120
120
DIN
00950896
00950899
00950900
00950902
00950907
01900927
01900935
01902628
01902644
01902652
01902660
01905082
01905090
01907107
01907115
01907123
01907476
01908294
01908448
01908871
01908901
01910086
01910124
01910132
01910140
01910159
01910167
01910272
01910299
01911465
01911473
01911481
01911627
01911635
01911902
01911910
01911929
01912038
01912046
01912054
01912062
01912070
01912437
01912828
01913204
01913220
01913239
01913247
01913425
01913433
01913441
01913468
01913476
01913484
01913492
01913506
01913654
01913662
01913670
01913689
01913786
01913794
01913808
01913816
01913824
01913832
01913840
01913859
PAGE
120
213
120
120
120
171
171
180
17
17
17
141
141
63
63
71
200
134
139
198
198
180
194
194
46
46
46
191
191
61
61
61
14
14
72
72
72
78
78
47
47
147
198
137
63
61
112
112
97
97
97
97
97
112
112
115
171
171
171
171
61
67
67
67
60
60
60
61
DIN
01913999
01914006
01914030
01914138
01914146
01916181
01916203
01916386
01916823
01916858
01916866
01916874
01916882
01916947
01917021
01917056
01918303
01918311
01918338
01918346
01918354
01918362
01918486
01919342
01919369
01919458
01919466
01919598
01924516
01924559
01924567
01924613
01924621
01924753
01924761
01925199
01925350
01925679
01925997
01926284
01926292
01926306
01926322
01926349
01926357
01926373
01926381
01926403
01926454
01926462
01926470
01926489
01926497
01926500
01926519
01926527
01926543
01926551
01926578
01926667
01926675
01926691
01926756
01926764
01926780
01926853
01926861
01926934
PAGE
14
14
151
12
12
135
135
84
154
9
9
9
9
180
98
77
124
41
41
41
42
42
56
98
99
176
176
102
111
111
111
82
82
202
202
198
189
168
198
103
219
219
103
103
103
79
79
79
73
197
197
197
197
197
197
197
46
46
46
108
108
173
108
108
108
21
184
32
DIN
PAGE
01927167
01927604
01927612
01927620
01927647
01927655
01927663
01927671
01927701
01927728
01927744
01927752
01927760
01927779
01927787
01927795
01927914
01929968
01929976
01929984
01929992
01934155
01934198
01934201
01934228
01934317
01934392
01934406
01937219
01937227
01937235
01937383
01937391
01937405
01937413
01939130
01940414
01940430
01940449
01940457
01940473
01940481
01940511
01940538
01940546
01940554
01940635
01942964
01942972
01942980
01942999
01943200
01944355
01944363
01944444
01945149
01945203
01945270
01946242
01946250
01946269
01946277
01946323
01946374
01947664
01947672
01947680
01947699
328
135
154
154
154
117
117
117
117
117
117
28
108
108
109
109
109
189
104
104
104
104
183
67
67
67
71
31
31
59
102
103
84
84
84
84
206
139
103
103
103
101
101
16
16
16
16
16
60
60
60
61
206
2
2
189
199
33
133
97
96
96
97
17
200
67
67
67
67
DIN
01947796
01947818
01947826
01947923
01947931
01947958
01948598
01948784
01948792
01948806
01950541
01950681
01953834
01953842
01958097
01958100
01958119
01959212
01959220
01959239
01962655
01962701
01962728
01962779
01962817
01964054
01964070
01964399
01964402
01964909
01964925
01964933
01964968
01964976
01966197
01966200
01966219
01968017
01968300
01968432
01968440
01976133
01977547
01977563
01977601
01978918
01978926
01979574
01979582
01981242
01981250
01981501
01984853
01985205
01986864
01987003
01987682
01988840
01989553
01989561
01990403
01990896
01992872
01995227
01997580
01997602
01997629
01997637
PAGE
55
55
55
28
28
28
138
96
97
97
140
30
148
148
62
62
62
170
169
169
170
193
193
102
102
195
160
108
108
117
117
117
160
160
50
50
203
43
135
43
165
199
160
162
162
159
159
57
57
156
156
211
7
146
32
206
180
180
50
50
14
17
165
115
151
36
212
20
DIN
01997653
01997750
01999559
01999761
01999788
01999796
01999818
01999826
01999834
01999842
01999850
01999869
02004828
02004836
02006383
02007134
02007959
02009706
02009749
02009765
02009773
02010267
02010283
02010291
02010909
02011239
02011271
02011921
02011948
02011956
02012472
02014165
02014173
02014181
02014203
02014211
02014238
02014246
02014254
02014262
02014270
02014289
02014297
02014300
02014319
02014327
02015439
02015951
02016095
02017237
02017539
02017598
02017628
02017636
02017709
02017733
02017741
02018144
02018152
02018160
02018985
02019809
02019930
02019949
02019957
02019965
02020599
02020602
PAGE
36
2
60
162
195
195
195
195
195
195
195
162
63
63
31
173
42
86
85
85
85
181
193
193
212
117
73
193
181
132
40
203
88
203
85
85
85
87
86
87
202
202
86
86
87
87
86
79
144
81
18
207
89
89
19
184
124
162
162
162
98
2
86
86
86
86
103
103
DIN
PAGE
02020610
02020629
02020661
02020688
02020696
02020718
02020726
02020734
02020742
02022125
02022133
02022141
02022826
02023725
02023733
02023741
02023768
02023814
02023830
02023865
02024152
02024187
02024195
02024209
02024217
02024225
02024233
02024241
02024268
02024276
02024284
02024292
02024306
02024314
02024322
02025248
02025280
02025299
02025302
02025310
02025736
02026759
02026767
02026961
02028700
02028786
02029421
02029448
02030810
02031094
02031116
02031159
02031167
02031175
02032376
02034468
02035324
02036282
02036290
02036347
02036355
02036436
02036444
02039486
02039494
02039532
02039540
02040751
329
103
103
78
78
78
78
78
171
171
32
148
148
14
138
138
138
135
137
133
134
3
191
148
148
170
169
169
169
169
170
169
170
170
170
170
170
109
109
109
109
137
30
191
124
165
215
165
217
50
182
4
140
140
79
138
14
134
46
46
8
8
46
46
77
77
47
47
96
DIN
02040778
02040786
02041413
02041421
02041448
02042177
02042231
02042258
02042266
02042274
02042304
02042320
02042339
02042355
02042479
02042487
02042533
02042541
02042568
02042576
02042584
02043033
02043041
02043394
02043408
02043416
02043424
02043440
02043726
02043734
02044609
02044617
02044668
02044676
02044692
02044706
02045680
02045699
02045702
02045710
02045729
02045737
02045834
02045869
02046113
02046121
02046148
02046156
02046253
02046261
02046733
02046741
02047454
02047462
02047799
02047802
02048493
02048507
02048523
02048639
02048698
02048728
02048736
02049325
02049333
02049341
02049376
02049384
PAGE
96
96
114
114
114
54
54
54
54
54
124
163
163
89
163
163
163
163
92
82
82
163
163
166
166
166
166
166
163
163
55
55
11
11
54
54
127
127
150
172
65
65
145
145
219
61
61
72
76
76
130
33
4
52
180
180
77
77
141
191
77
90
90
213
64
126
64
64
DIN
02049392
02049961
02049988
02049996
02050005
02050013
02050021
02050048
02050056
02051850
02052431
02052717
02053187
02053195
02056704
02056712
02057778
02057808
02057816
02057824
02058413
02058456
02058464
02059762
02059789
02060590
02060868
02060884
02061562
02061570
02063662
02063735
02063743
02063786
02063808
02064472
02064480
02065819
02068036
02068087
02069571
02070847
02070863
02070987
02074788
02076306
02078627
02078635
02078651
02080052
02083345
02083353
02083523
02083531
02083558
02084090
02084104
02084228
02084236
02084260
02084279
02084287
02084295
02084309
02084317
02084325
02084333
02084341
PAGE
216
59
59
97
97
97
97
97
97
8
190
206
102
103
31
31
63
52
53
53
77
57
57
217
217
165
134
190
57
57
20
36
36
217
149
151
151
95
95
218
33
199
199
103
199
139
13
14
14
36
141
141
56
80
80
12
12
55
55
93
93
93
182
182
141
141
32
171
DIN
PAGE
02084376
02084384
02084392
02084449
02084457
02085852
02085887
02085895
02086026
02087324
02087375
02087383
02087391
02088398
02088401
02089580
02089602
02089610
02089769
02089777
02089793
02091194
02091232
02091275
02091461
02091488
02091526
02092832
02093103
02093162
02097141
02097168
02097176
02097214
02097222
02097230
02097249
02097257
02097265
02097273
02097370
02097389
02099128
02099136
02099225
02099233
02099675
02099683
02100304
02100509
02100517
02100622
02100630
02102978
02103036
02103095
02103567
02103613
02103656
02103680
02103702
02103729
02103737
02106272
02106280
02108143
02108151
02108186
330
52
53
53
36
36
182
171
85
160
211
100
100
100
36
36
124
189
189
168
168
168
77
11
105
168
168
130
184
11
191
30
30
30
49
49
49
49
49
49
50
48
48
96
97
219
172
151
151
168
78
78
150
94
29
184
29
150
147
90
104
104
65
90
64
64
12
12
167
DIN
02108194
02112736
02112752
02112760
02112787
02112795
02112809
02115514
02115522
02122197
02123274
02123282
02123312
02123320
02123339
02123347
02125102
02125145
02125226
02125250
02125323
02125331
02125366
02125382
02125390
02125447
02126168
02126176
02126184
02126192
02126222
02126249
02126257
02126559
02126605
02126710
02126753
02126761
02128950
02128969
02130033
02130084
02130092
02130106
02130165
02130173
02130297
02130300
02130874
02130963
02130971
02130998
02131013
02131048
02131056
02131064
02131625
02132591
02132621
02132648
02132664
02132680
02132699
02132702
02133296
02133318
02133342
02134829
PAGE
65
194
151
151
151
151
151
191
191
4
66
66
218
217
217
217
29
4
184
150
84
84
84
84
84
183
215
215
215
191
30
182
182
72
182
7
51
51
102
103
12
96
96
97
96
96
106
106
183
14
14
90
90
36
36
36
140
144
40
40
40
56
56
102
136
136
137
150
DIN
02134896
02136090
02136104
02136112
02136120
02137267
02137313
02137321
02137348
02137534
02137542
02137984
02138018
02138271
02138298
02139189
02139197
02139200
02139324
02139332
02139340
02139359
02139367
02139391
02139995
02140047
02140055
02140063
02140128
02141442
02142031
02142074
02142082
02142104
02142112
02143283
02143291
02143364
02143372
02144263
02144271
02145413
02145421
02145448
02145758
02145863
02145901
02145928
02145936
02145944
02145952
02145960
02146118
02146126
02146827
02146843
02146851
02146886
02146894
02146908
02146916
02146924
02146932
02146940
02146959
02147432
02147602
02147610
PAGE
138
36
36
82
82
87
54
54
54
112
112
89
85
36
36
56
56
14
33
36
96
96
96
36
67
94
94
94
97
3
77
57
93
93
93
148
134
78
79
102
103
50
51
219
3
85
84
85
85
88
88
88
85
85
88
32
32
82
47
7
48
48
79
79
56
47
46
46
DIN
PAGE
02147629
02147637
02147645
02148552
02148560
02148579
02148587
02148595
02148749
02148765
02148773
02150662
02150670
02150689
02150697
02150808
02150816
02150824
02150867
02150891
02150905
02150921
02150948
02150956
02152568
02153483
02153521
02153548
02153556
02153564
02154412
02154420
02154463
02154862
02154870
02155907
02155923
02155958
02155966
02155974
02155990
02156008
02156016
02156032
02156040
02156083
02156091
02157195
02158574
02158582
02158590
02158604
02158612
02158620
02158639
02161923
02161966
02161974
02162431
02162458
02162466
02162504
02162512
02162687
02162776
02162806
02162814
02162822
331
46
102
103
175
175
175
166
166
196
172
79
212
212
212
212
79
79
79
181
181
181
181
181
199
31
126
151
151
151
151
33
81
81
191
191
52
72
19
19
19
52
105
105
105
105
79
184
147
11
76
202
99
99
99
99
193
193
193
81
81
80
192
192
135
43
72
76
172
DIN
02162849
02163152
02163527
02163535
02163543
02163551
02163578
02163586
02163594
02163659
02163667
02163675
02163683
02163705
02163721
02163748
02163772
02163780
02163799
02163918
02163926
02163934
02163942
02165376
02165384
02165392
02165503
02165511
02165546
02165554
02165562
02166704
02166712
02166720
02166747
02167786
02167794
02167840
02168898
02168979
02169649
02170493
02170698
02170833
02170841
02171228
02171775
02171791
02171805
02171813
02171821
02171848
02171858
02171864
02171872
02171880
02171899
02171929
02172062
02172070
02172089
02172097
02172100
02172119
02172127
02172135
02172143
02172151
PAGE
172
193
72
72
202
60
60
60
61
6
6
6
6
139
30
83
55
83
83
83
82
82
83
32
102
103
148
148
46
46
46
175
141
141
100
172
55
41
166
25
214
206
199
55
55
176
182
47
47
81
81
36
113
113
113
141
141
151
176
176
176
176
176
176
176
176
176
176
DIN
02172550
02172569
02172577
02172712
02173344
02173352
02173360
02173506
02173514
02174545
02174553
02174677
02174685
02175983
02175991
02176009
02176017
02176076
02176084
02176092
02176106
02176122
02176130
02176149
02177072
02177102
02177145
02177153
02177161
02177188
02177579
02177587
02177595
02177617
02177625
02177633
02177641
02177668
02177676
02177684
02177692
02177706
02177714
02177722
02177749
02177757
02177781
02177803
02177846
02177854
02177889
02177897
02178729
02178737
02179679
02179687
02179709
02181479
02181487
02181495
02181509
02181517
02181525
02182815
02182823
02182831
02182858
02182866
PAGE
50
51
79
134
90
90
33
12
12
50
51
77
77
219
219
219
212
125
214
25
25
116
79
79
80
14
36
113
113
113
98
98
98
98
98
5
5
5
5
5
101
101
149
149
86
87
6
6
6
6
90
90
101
101
82
82
126
61
8
8
9
9
52
65
215
215
215
12
DIN
PAGE
02182874
02182882
02182963
02183862
02184435
02184443
02184451
02184648
02185407
02185415
02185423
02185814
02185830
02185849
02185857
02185865
02185873
02186802
02187086
02187094
02187108
02187116
02187876
02188783
02188929
02188937
02188945
02188953
02188961
02188988
02188996
02189003
02189011
02189038
02189046
02189054
02189062
02190885
02190893
02190915
02192268
02192276
02192284
02192659
02192667
02192683
02192691
02192705
02192713
02192721
02192748
02192756
02192764
02194031
02194058
02194090
02194155
02194163
02194171
02194198
02194201
02194228
02194236
02194333
02194341
02195704
02195917
332
65
65
199
144
86
86
86
94
57
25
25
149
5
5
5
5
5
14
164
164
164
164
69
216
60
60
60
61
47
47
96
96
96
48
48
164
164
171
171
149
189
189
189
12
144
16
16
113
113
113
216
98
98
195
195
161
162
182
182
4
4
182
182
92
199
182
25
DIN
02195925
02195933
02195941
02195968
02195984
02195992
02196018
02196026
02197405
02197413
02197421
02197448
02197456
02197464
02197502
02199270
02199289
02199297
02200104
02200864
02200937
02200996
02201011
02201038
02202441
02202468
02202476
02202484
02203324
02204401
02204428
02204436
02204444
02204517
02204525
02204533
02204576
02204584
02206072
02207621
02207648
02207656
02207672
02207761
02207788
02207818
02208229
02208237
02208245
02209071
02210320
02210347
02210355
02210363
02210428
02210479
02211076
02211130
02211149
02211742
02211920
02211939
02211947
02211955
02211963
02211971
02212005
02212021
PAGE
25
215
215
215
5
5
148
148
13
14
14
52
140
140
164
219
14
164
145
133
52
55
210
210
88
88
88
88
145
167
167
167
167
46
46
46
174
174
42
13
14
14
116
150
150
90
32
33
32
140
56
71
71
71
55
30
116
106
106
33
71
96
96
97
97
97
144
7
DIN
02212048
02212102
02212153
02212161
02212188
02212277
02212285
02212307
02212331
02212374
02212390
02213192
02213206
02213214
02213222
02213230
02213265
02213273
02213281
02213419
02213478
02213486
02213583
02213591
02213605
02213613
02213672
02213834
02214261
02214415
02214423
02214997
02215004
02215136
02216086
02216094
02216108
02216116
02216132
02216140
02216159
02216183
02216205
02216213
02216221
02216248
02216256
02216264
02216272
02216280
02216353
02216361
02216582
02216590
02216949
02216965
02217015
02217058
02217066
02217422
02217481
02217503
02217511
02218305
02218321
02218410
02218453
02218461
PAGE
36
52
35
35
35
6
6
6
150
150
32
176
176
176
176
176
191
191
191
32
32
33
160
160
160
160
135
136
33
191
191
32
32
174
17
17
17
17
117
117
117
174
138
191
30
96
96
97
97
97
98
98
98
98
32
18
24
24
24
21
64
64
64
214
94
100
98
99
DIN
PAGE
02218941
02218968
02218976
02218984
02219077
02219085
02219492
02219905
02220059
02220156
02220164
02220172
02220180
02220385
02220407
02221284
02221292
02221306
02221330
02221780
02221799
02221802
02221810
02221829
02221837
02221845
02221853
02221896
02221918
02221926
02221934
02221950
02221977
02221985
02221993
02222000
02222051
02222957
02222965
02222973
02223139
02223147
02223325
02223333
02223341
02223368
02223376
02223406
02223511
02223538
02223562
02223570
02223589
02223597
02223678
02223716
02223724
02223856
02223864
02224100
02224550
02224569
02224623
02224631
02224690
02224704
02224720
02224836
333
69
69
69
69
150
150
14
183
202
149
149
57
57
198
184
175
175
175
214
40
92
181
181
68
68
68
68
192
192
192
192
82
43
63
63
63
58
49
49
49
101
101
96
97
96
97
202
24
101
101
172
115
115
126
126
7
7
198
198
90
171
171
136
136
125
125
125
50
DIN
02225158
02225166
02225190
02225964
02225972
02226839
02227339
02227444
02227452
02227460
02228203
02228211
02228343
02228351
02228947
02229099
02229110
02229129
02229145
02229161
02229196
02229250
02229269
02229277
02229285
02229293
02229315
02229323
02229406
02229407
02229408
02229440
02229441
02229452
02229453
02229455
02229456
02229467
02229468
02229515
02229516
02229517
02229524
02229526
02229540
02229550
02229552
02229569
02229617
02229628
02229650
02229651
02229652
02229653
02229654
02229655
02229656
02229704
02229705
02229718
02229719
02229720
02229722
02229723
02229755
02229756
02229758
02229778
PAGE
211
211
166
115
115
184
126
147
147
147
76
77
144
144
34
159
14
14
18
18
18
107
107
107
107
147
191
191
49
49
49
132
132
79
149
115
115
47
47
41
172
172
20
50
162
162
144
79
10
94
48
48
48
48
90
90
172
170
170
147
147
147
174
24
41
115
115
55
DIN
02229779
02229781
02229782
02229783
02229784
02229785
02229837
02229838
02229839
02229840
02229874
02229994
02230019
02230020
02230047
02230085
02230086
02230087
02230090
02230095
02230102
02230183
02230203
02230204
02230205
02230206
02230256
02230263
02230264
02230284
02230285
02230302
02230321
02230322
02230359
02230360
02230366
02230368
02230369
02230386
02230394
02230401
02230402
02230403
02230404
02230405
02230406
02230418
02230420
02230431
02230432
02230433
02230448
02230449
02230454
02230475
02230476
02230477
02230543
02230580
02230584
02230585
02230619
02230641
02230648
02230663
02230666
02230667
PAGE
55
49
49
49
50
172
77
175
175
175
183
172
146
146
65
203
203
203
43
115
115
57
60
60
60
61
96
5
5
102
103
83
111
111
51
51
90
90
90
137
202
43
111
111
111
110
110
35
35
148
148
148
50
51
211
172
57
81
216
57
113
113
161
218
134
94
113
113
DIN
PAGE
02230668
02230670
02230711
02230713
02230714
02230717
02230730
02230732
02230733
02230734
02230735
02230736
02230737
02230768
02230784
02230785
02230800
02230803
02230804
02230805
02230806
02230807
02230808
02230827
02230828
02230837
02230838
02230839
02230840
02230874
02230888
02230889
02230891
02230892
02230893
02230894
02230896
02230897
02230898
02230941
02230942
02230950
02230951
02230997
02230998
02230999
02231015
02231030
02231036
02231052
02231053
02231054
02231060
02231061
02231089
02231121
02231122
02231129
02231135
02231136
02231143
02231150
02231151
02231152
02231154
02231155
02231171
02231181
334
113
172
56
56
56
218
214
72
72
72
12
12
149
94
200
200
202
50
51
69
69
69
69
82
82
107
107
107
107
116
132
132
166
166
94
94
94
2
31
116
116
90
90
49
49
49
20
94
218
49
49
49
82
4
202
50
51
33
30
30
7
49
49
49
50
50
40
55
DIN
02231182
02231184
02231192
02231193
02231208
02231245
02231287
02231288
02231290
02231327
02231328
02231329
02231330
02231347
02231348
02231353
02231390
02231431
02231432
02231433
02231441
02231457
02231459
02231460
02231477
02231478
02231480
02231488
02231491
02231492
02231493
02231494
02231502
02231503
02231504
02231505
02231506
02231508
02231509
02231510
02231536
02231537
02231539
02231543
02231544
02231583
02231584
02231585
02231586
02231587
02231592
02231615
02231616
02231650
02231662
02231663
02231664
02231665
02231671
02231675
02231676
02231677
02231678
02231679
02231680
02231683
02231684
02231686
PAGE
55
126
98
99
79
30
147
147
147
80
98
98
99
4
183
36
140
219
5
5
73
70
70
70
147
41
183
32
210
116
139
30
76
76
76
77
77
77
167
167
52
53
53
92
92
42
42
42
42
42
196
115
115
52
76
76
76
77
219
30
71
71
33
214
214
102
103
101
DIN
02231687
02231691
02231693
02231702
02231731
02231733
02231780
02231781
02231782
02231783
02231784
02231785
02231799
02231800
02231923
02231934
02232043
02232044
02232148
02232150
02232191
02232193
02232195
02232317
02232318
02232389
02232391
02232564
02232565
02232567
02232568
02232569
02232570
02232872
02232903
02232904
02232905
02232987
02233014
02233047
02233048
02233049
02233050
02233960
02233982
02233985
02233998
02233999
02234003
02234007
02234008
02234013
02234502
02234503
02234504
02234505
02234513
02234514
02234749
02236466
02236506
02236507
02236508
02236564
02236606
02236733
02236734
02236758
PAGE
101
5
5
211
47
47
56
101
101
32
33
30
79
79
134
88
212
212
99
100
191
191
191
77
77
82
10
116
218
218
218
218
32
24
117
117
117
33
213
69
69
69
69
90
90
90
144
172
90
90
55
55
69
69
69
69
171
171
111
147
36
36
36
40
220
171
171
52
DIN
PAGE
02236783
02236799
02236807
02236808
02236809
02236819
02236841
02236842
02236859
02236866
02236876
02236883
02236913
02236949
02236950
02236951
02236952
02236953
02236974
02236975
02236996
02236997
02237111
02237112
02237145
02237146
02237147
02237148
02237149
02237224
02237225
02237235
02237244
02237245
02237246
02237247
02237264
02237265
02237268
02237269
02237270
02237275
02237277
02237278
02237279
02237280
02237282
02237289
02237292
02237294
02237295
02237313
02237314
02237319
02237320
02237367
02237368
02237370
02237371
02237373
02237374
02237375
02237379
02237397
02237398
02237399
02237400
02237484
335
31
210
94
70
70
210
19
19
210
106
139
40
41
211
109
109
109
109
163
163
193
193
99
100
217
217
217
148
148
31
31
4
160
160
160
160
112
112
116
55
55
36
90
90
104
104
104
218
57
115
115
12
12
214
214
67
67
3
3
58
58
58
134
100
100
100
100
216
DIN
02237500
02237501
02237502
02237514
02237534
02237535
02237536
02237537
02237560
02237600
02237601
02237618
02237651
02237652
02237653
02237654
02237671
02237682
02237701
02237721
02237722
02237723
02237770
02237791
02237813
02237814
02237820
02237821
02237824
02237825
02237826
02237830
02237835
02237858
02237860
02237868
02237875
02237876
02237885
02237886
02237887
02237907
02237908
02237921
02237922
02237923
02237924
02237925
02237971
02237991
02238042
02238046
02238047
02238048
02238073
02238102
02238123
02238162
02238171
02238172
02238209
02238216
02238217
02238222
02238223
02238280
02238281
02238282
PAGE
5
5
5
19
107
107
107
107
43
47
47
52
107
107
107
107
212
20
43
46
46
46
214
71
98
98
34
34
95
95
79
94
159
116
174
138
12
12
46
46
46
92
92
70
70
64
64
64
174
140
94
53
53
94
137
218
219
114
8
8
150
215
215
92
92
102
102
102
DIN
02238315
02238326
02238327
02238334
02238340
02238348
02238370
02238403
02238404
02238405
02238406
02238465
02238525
02238526
02238551
02238552
02238553
02238554
02238568
02238577
02238578
02238604
02238617
02238618
02238633
02238634
02238635
02238636
02238639
02238645
02238660
02238674
02238675
02238682
02238703
02238704
02238748
02238770
02238771
02238796
02238797
02238817
02238829
02238830
02238831
02238850
02238873
02238984
02238998
02239007
02239008
02239024
02239025
02239028
02239064
02239065
02239068
02239069
02239083
02239091
02239092
02239131
02239146
02239170
02239193
02239213
02239238
02239239
PAGE
147
55
55
92
218
15
94
117
117
117
117
135
148
210
60
60
60
61
135
134
195
124
18
18
36
55
55
211
80
83
35
24
24
43
182
166
15
141
141
134
92
94
9
9
9
107
137
220
73
145
145
90
90
168
202
202
192
192
18
59
59
30
217
37
16
16
12
12
DIN
PAGE
02239288
02239323
02239324
02239325
02239365
02239366
02239517
02239518
02239519
02239535
02239577
02239607
02239608
02239619
02239620
02239627
02239630
02239665
02239667
02239668
02239698
02239699
02239700
02239701
02239702
02239703
02239713
02239714
02239730
02239738
02239744
02239746
02239747
02239748
02239751
02239752
02239754
02239755
02239756
02239757
02239758
02239759
02239760
02239761
02239762
02239769
02239770
02239771
02239772
02239834
02239864
02239886
02239887
02239888
02239893
02239907
02239908
02239912
02239913
02239917
02239918
02239919
02239920
02239921
02239924
02239925
02239926
02239941
336
135
216
216
216
32
33
92
92
93
144
133
95
95
126
126
139
3
111
12
12
92
92
93
92
92
93
94
94
213
35
43
99
100
100
98
98
46
46
46
180
46
46
46
8
8
70
70
50
51
214
56
15
15
15
4
94
94
150
126
126
107
107
107
107
173
173
173
76
DIN
02239942
02239951
02239953
02239954
02240035
02240067
02240071
02240072
02240113
02240114
02240115
02240131
02240132
02240205
02240210
02240248
02240249
02240294
02240321
02240329
02240331
02240332
02240335
02240337
02240346
02240357
02240358
02240362
02240363
02240431
02240432
02240456
02240457
02240458
02240481
02240484
02240485
02240498
02240499
02240500
02240508
02240518
02240519
02240520
02240521
02240550
02240551
02240552
02240588
02240589
02240590
02240601
02240622
02240623
02240682
02240683
02240684
02240685
02240687
02240693
02240694
02240695
02240754
02240755
02240769
02240770
02240775
02240789
PAGE
76
57
98
99
136
126
46
139
139
41
93
88
88
41
56
141
141
170
71
207
56
58
20
56
4
15
15
14
132
63
63
100
149
149
102
102
102
62
62
62
139
35
35
35
35
202
109
109
62
62
62
71
148
148
98
99
160
160
160
24
24
24
149
149
68
68
173
101
DIN
02240790
02240807
02240835
02240836
02240837
02240862
02240867
02240868
02241003
02241007
02241107
02241108
02241109
02241112
02241113
02241114
02241148
02241149
02241159
02241163
02241224
02241225
02241285
02241332
02241347
02241348
02241371
02241374
02241480
02241574
02241575
02241594
02241608
02241674
02241704
02241709
02241710
02241715
02241716
02241731
02241732
02241755
02241818
02241819
02241820
02241821
02241835
02241837
02241882
02241883
02241887
02241888
02241889
02241895
02241900
02241901
02241928
02241933
02241983
02242003
02242005
02242029
02242030
02242055
02242115
02242116
02242117
02242118
PAGE
101
4
33
33
33
109
80
80
134
65
81
81
81
173
173
173
47
47
213
34
77
77
202
166
98
99
98
98
18
140
140
217
57
165
57
12
12
140
140
141
141
133
64
64
13
13
167
167
92
92
192
214
214
3
70
70
105
146
207
85
85
159
159
156
218
218
218
218
DIN
PAGE
02242119
02242146
02242177
02242178
02242232
02242320
02242321
02242322
02242323
02242327
02242328
02242361
02242362
02242374
02242453
02242454
02242463
02242464
02242465
02242471
02242503
02242518
02242519
02242520
02242521
02242538
02242539
02242540
02242541
02242572
02242573
02242574
02242589
02242631
02242652
02242656
02242657
02242680
02242681
02242682
02242683
02242684
02242685
02242687
02242726
02242728
02242729
02242730
02242738
02242784
02242785
02242786
02242788
02242789
02242790
02242791
02242793
02242794
02242814
02242822
02242823
02242824
02242825
02242826
02242837
02242838
02242865
02242866
337
71
151
98
98
138
48
48
48
48
148
148
106
106
145
150
150
14
14
174
211
4
217
102
102
102
49
49
49
50
172
172
172
172
106
3
6
6
41
41
41
41
42
42
42
172
62
62
62
192
13
80
80
60
60
60
61
172
172
144
100
100
100
100
62
117
117
58
58
DIN
02242867
02242878
02242879
02242903
02242907
02242908
02242909
02242912
02242919
02242924
02242925
02242926
02242927
02242928
02242929
02242965
02242966
02242967
02242968
02242969
02242974
02242984
02242985
02243005
02243023
02243024
02243026
02243038
02243039
02243045
02243077
02243078
02243085
02243086
02243087
02243097
02243098
02243116
02243117
02243127
02243129
02243144
02243158
02243182
02243215
02243216
02243217
02243218
02243219
02243229
02243230
02243237
02243297
02243324
02243325
02243327
02243338
02243339
02243340
02243341
02243348
02243349
02243350
02243351
02243401
02243403
02243446
02243447
PAGE
58
166
166
212
210
92
92
80
184
41
41
41
42
42
42
20
25
25
25
25
172
194
194
165
115
115
139
150
150
35
174
174
147
107
107
56
130
21
21
57
57
219
198
19
62
62
62
100
100
150
150
218
213
53
53
43
49
49
49
50
100
100
9
9
42
42
93
93
DIN
02243448
02243450
02243486
02243487
02243506
02243507
02243508
02243518
02243519
02243520
02243521
02243529
02243530
02243538
02243539
02243541
02243542
02243543
02243552
02243562
02243587
02243588
02243602
02243643
02243644
02243684
02243722
02243724
02243727
02243728
02243743
02243744
02243745
02243746
02243747
02243748
02243749
02243763
02243770
02243771
02243790
02243796
02243808
02243827
02243828
02243861
02243862
02243878
02243894
02243895
02243910
02243942
02243986
02243987
02243999
02244000
02244001
02244002
02244016
02244021
02244022
02244023
02244107
02244125
02244138
02244139
02244140
02244148
PAGE
93
156
98
98
58
58
58
69
69
69
69
167
167
64
64
17
17
17
56
84
43
73
215
18
18
13
167
167
53
53
93
93
93
69
69
69
69
212
9
9
207
149
43
30
32
132
132
71
200
200
99
63
9
9
167
167
167
167
213
59
149
149
109
149
92
92
93
200
DIN
PAGE
02244149
02244166
02244291
02244292
02244293
02244298
02244299
02244300
02244304
02244305
02244306
02244309
02244310
02244344
02244350
02244351
02244352
02244353
02244393
02244394
02244403
02244462
02244463
02244464
02244465
02244466
02244467
02244494
02244495
02244496
02244513
02244514
02244515
02244527
02244528
02244529
02244550
02244551
02244552
02244563
02244596
02244597
02244598
02244599
02244612
02244613
02244638
02244641
02244646
02244647
02244680
02244681
02244726
02244727
02244756
02244757
02244790
02244791
02244792
02244798
02244838
02244839
02244840
02244842
02244896
02244914
02244981
02244982
338
200
105
160
160
160
213
213
213
93
93
93
218
218
68
58
58
58
169
6
6
91
41
41
41
42
42
42
215
215
215
93
93
93
62
62
62
217
217
217
80
16
16
16
16
202
202
92
7
9
9
89
89
175
175
7
15
86
86
86
199
102
102
102
202
141
32
211
211
DIN
02244999
02245101
02245102
02245103
02245111
02245126
02245127
02245159
02245160
02245161
02245202
02245203
02245204
02245205
02245208
02245209
02245210
02245232
02245233
02245284
02245285
02245286
02245292
02245293
02245329
02245372
02245373
02245385
02245386
02245397
02245438
02245439
02245440
02245522
02245523
02245524
02245532
02245565
02245618
02245619
02245643
02245644
02245662
02245688
02245697
02245748
02245749
02245750
02245751
02245752
02245753
02245754
02245755
02245756
02245757
02245784
02245785
02245786
02245787
02245788
02245789
02245822
02245823
02246013
02246014
02246046
02246047
PAGE
136
100
100
100
100
33
33
102
102
102
100
100
100
100
93
93
93
12
12
86
86
86
3
3
210
53
53
31
31
169
172
172
172
191
191
191
161
210
41
213
3
3
181
190
3
102
102
102
92
92
93
100
100
100
100
114
114
114
102
102
102
57
57
57
57
149
149
INDEX D
ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCT NAMES
PRODUCT NAME
292
3TC (EDS)
5-AMINOSALICYLIC ACID
642
ABACAVIR SO4
ABACAVIR SO4/
ACARBOSE
ACCOLATE (EDS)
ACCU-CHEK COMPACT
ACCUPRIL
ACCURETIC
ACCUTANE
ACCUTREND
ACEBUTOLOL HCL
"
ACENOCOUMAROL
ACETAMINOPHEN/CAFFEINE/
CODEINE
ACETAMINOPHEN/CODEINE
ACETAZOLAMIDE
"
ACETEST
ACETOXYL
ACETYLCYSTEINE
ACETYLCYSTEINE SOLUTION
ACETYLSALICYLIC ACID/
CAFFEINE/CODEINE
ACITRETIN
ACTONEL (EDS)
ACTOS (EDS)
ACULAR (EDS)
ACYCLOVIR
ADALAT XL
ADAPALENE
ADRENALIN
ADVAIR (EDS)
ADVAIR DISKUS (EDS)
ADVANTAGE COMFORT
AGENERASE (EDS)
AGGRENOX (EDS)
AGRYLIN
AIROMIR
ALCOMICIN
ALDACTAZIDE-25
ALDACTAZIDE-50
ALDACTONE
ALENDRONATE SODIUM
ALERTEC (EDS)
ALESSE
ALFACALCIDOL
ALFUZOSIN
ALLOPURINOL
ALOMIDE
ALPHAGAN
ALPRAZOLAM
ALTACE
ALUMINUM ACETATE/
BENZETHONIUM CHLORIDE
"
ALUPENT
Page
83
16
151
88
15
15
171
220
120
67
67
200
120
46
58
40
82
83
125
137
121
198
130
130
76
83
199
217
172
135
13
52
196
31
33
33
120
17
71
210
32
132
68
68
126
210
111
163
207
210
210
140
139
112
68
133
196
31
339
PRODUCT NAME
AMANTADINE
AMATINE (EDS)
AMCINONIDE
AMERGE (EDS)
AMETHOPTERIN
AMILORIDE HCL
AMILORIDE HCL/
HYDROCHLOROTHIAZIDE
AMINOPHYLLINE
AMIODARONE
AMITRIPTYLINE
AMLODIPINE BESYLATE
AMOBARBITAL SODIUM
AMOXICILLIN TRIHYDRATE/
POTASSIUM CLAVULANATE
AMPICILLIN
AMPRENAVIR
AMYTAL SODIUM
ANAFRANIL
ANAGRELIDE HCL
ANDRIOL
ANDROCUR (EDS)
ANSAID
ANTHRAFORTE-1
ANTHRAFORTE-2
ANTHRANOL
ANTHRASCALP
APO-ACEBUTOLOL
APO-ACETAZOLAMIDE
APO-ACYCLOVIR
"
APO-ALLOPURINOL
APO-ALPRAZ
APO-AMILZIDE
APO-AMITRIPTYLINE
APO-AMOXI
"
APO-AMPI
APO-ATENOL
APO-AZATHIOPRINE
APO-BACLOFEN
APO-BECLOMETHASONE
APO-BENZTROPINE
APO-BROMAZEPAM
APO-BROMOCRIPTINE
APO-BUSPIRONE
APO-CAPTO
"
APO-CARBAMAZEPINE
APO-CEFACLOR (EDS)
APO-CEPHALEX
APO-CHLORPROPAMIDE
APO-CHLORTHALIDONE
APO-CIMETIDINE
APO-CLINDAMYCIN
APO-CLOBAZAM
APO-CLOMIPRAMINE
APO-CLONAZEPAM
Page
14
31
189
34
199
126
59
202
46
95
47
112
8
9
10
17
112
96
210
162
24
78
198
198
198
198
46
137
13
14
210
112
59
95
8
9
9
10
47
210
36
134
28
113
211
116
60
61
92
92
5
6
6
113
171
125
147
12
92
96
90
PRODUCT NAME
APO-CLONIDINE
APO-CLORAZEPATE
APO-CLOXI
APO-CROMOLYN
"
APO-CYCLOBENZAPRINE (EDS)
APO-DESIPRAMINE
"
APO-DESMOPRESSIN (EDS)
APO-DIAZEPAM
APO-DICLO
APO-DICLO SR
"
APO-DIFLUNISAL
APO-DILTIAZ
APO-DILTIAZ CD
"
APO-DILTIAZ SR
APO-DIMENHYDRINATE
APO-DIPIVEFRIN
APO-DIVALPROEX
"
APO-DOMPERIDONE
APO-DOXAZOSIN
APO-DOXEPIN
APO-DOXY
APO-ERYTHRO-BASE
APO-ERYTHRO-S
APO-ETODOLAC (EDS)
APO-FAMOTIDINE
APO-FENO-MICRO
APO-FLAVOXATE (EDS)
APO-FLOCTAFENINE
APO-FLUCONAZOLE
APO-FLUNISOLIDE
APO-FLUOXETINE
APO-FLUPHENAZINE
APO-FLURAZEPAM
APO-FLURBIPROFEN
APO-FLUVOXAMINE
"
APO-FOLIC
APO-FUROSEMIDE
APO-GABAPENTIN
APO-GEMFIBROZIL
APO-GLYBURIDE
APO-HALOPERIDOL
APO-HALOPERIDOL LA
APO-HYDRALAZINE
APO-HYDRO
APO-HYDROXYZINE
APO-IBUPROFEN
APO-IMIPRAMINE
APO-INDAPAMIDE
APO-INDOMETHACIN
"
APO-IPRAVENT
APO-ISDN
APO-K
APO-KETO
APO-KETOCONAZOLE (EDS)
APO-KETOPROFEN SR
APO-KETOTIFEN (EDS)
APO-LABETALOL
APO-LACTULOSE (EDS)
APO-LAMOTRIGINE
APO-LEVOBUNOLOL
Page
61
113
10
140
219
36
96
97
174
114
76
76
77
77
48
49
50
49
146
138
92
93
147
62
97
11
7
8
77
148
56
202
89
3
3
135
98
105
114
78
98
99
206
125
93
57
171
106
106
63
125
116
78
99
126
78
79
30
72
124
79
4
79
214
64
144
93
140
340
PRODUCT NAME
APO-LEVOCARB
APO-LISINOPRIL
APO-LOPERAMIDE
APO-LORAZEPAM
APO-LOVASTATIN
APO-LOXAPINE
APO-MEDROXY
APO-MEFENAMIC
APO-MEGESTROL (EDS)
APO-METFORMIN
APO-METHAZIDE-15
APO-METHAZIDE-25
APO-METHOPRAZINE
APO-METHYLDOPA
APO-METOCLOP
APO-METOPROLOL
"
"
APO-METRONIDAZOLE
APO-MISOPROSTOL
APO-MOCLOBEMIDE
"
APO-NABUMETONE (EDS)
APO-NADOL
APO-NAPROXEN
APO-NAPROXEN SR
APO-NEFAZODONE
APO-NIFED
APO-NIFED PA
APO-NITROFURANTOIN
APO-NIZATIDINE
APO-NORFLOX (EDS)
APO-NORTRIPTYLINE
APO-ORCIPRENALINE
APO-OXAZEPAM
APO-OXTRIPHYLLINE
APO-OXYBUTYNIN
APO-PENTOXIFYLLINE SR
APO-PEN-VK
APO-PERPHENAZINE
APO-PHENYLBUTAZONE
APO-PINDOL
"
APO-PIROXICAM
APO-PRAVASTATIN
APO-PRAZO
APO-PREDNISONE
APO-PRIMIDONE
APO-PROCAINAMIDE
APO-PROCHLORAZINE
APO-PROPAFENONE
APO-PROPRANOLOL
APO-QUINIDINE
APO-RANITIDINE
APO-SALVENT
"
APO-SELEGILINE (EDS)
APO-SERTRALINE
APO-SOTALOL
APO-SUCRALFATE
APO-SULFATRIM
"
APO-SULFATRIM DS
APO-SULFINPYRAZONE
APO-SULIN
Page
215
64
117
144
114
57
107
175
79
25
172
65
65
117
65
148
50
51
50
51
21
12
149
99
100
80
51
80
80
100
52
52
20
149
20
101
31
115
203
202
43
10
108
81
52
53
81
58
67
161
89
53
108
53
54
54
150
32
33
218
102
55
150
21
22
22
127
82
PRODUCT NAME
APO-TEMAZEPAM
APO-TERAZOSIN
APO-TERBINAFINE
APO-TETRA
APO-THEO-LA
APO-THIORIDAZINE
APO-TIAPROFENIC
APO-TICLOPIDINE (EDS)
APO-TIMOL
APO-TIMOP
APO-TOLBUTAMIDE
APO-TRAZODONE
"
APO-TRIAZIDE
APO-TRIAZO
APO-TRIFLUOPERAZINE
APO-TRIHEX
APO-TRIMETHOPRIM
APO-TRIMIP
APO-VALPROIC
APO-VERAP
APO-WARFARIN
"
APO-ZIDOVUDINE (EDS)
APRACLONIDINE HCL
APRESOLINE
ARALEN
ARAVA (EDS)
AREDIA (EDS)
ARICEPT (EDS)
ARISTOCORT
ARISTOCORT R
ARISTOSPAN (EDS)
ARTHROTEC
ARTHROTEC 75
ASACOL
ASCENSIA DEX
ATACAND
ATACAND PLUS
ATARAX
ATASOL-15
ATASOL-30
ATENOLOL
"
ATENOLOL/CHLORTHALIDONE
ATIVAN
ATORVASTATIN CALCIUM
ATOVAQUONE
ATROPINE
ATROPINE SO4
ATROVENT
ATROVENT NASAL SPRAY
AURANOFIN
AUROTHIOGLUCOSE
AVALIDE
AVANDIA (EDS)
AVAPRO
AVC
AVELOX (EDS)
AVENTYL
AVONEX (EDS)
AXID
AZATHIOPRINE
AZITHROMYCIN
AZOPT
BACLOFEN
BACTROBAN
BECLOMETHASONE
Page
115
69
4
12
203
110
82
43
55
141
173
102
103
70
115
110
29
21
103
94
70
41
42
17
139
63
18
214
217
212
161
195
162
77
77
151
120
59
59
116
82
82
47
59
59
114
56
21
138
138
30
139
154
154
64
173
64
184
20
101
214
149
210
7
137
36
180
341
PRODUCT NAME
DIPROPIONATE
"
"
BENAZEPRIL HCL
BENOXYL
BENTYLOL
BENURYL
BENZAC AC
BENZAC W
BENZAC-W
BENZAGEL
BENZOYL PEROXIDE
BENZTROPINE MESYLATE
BEROTEC
BEROTEC UDV
BETADERM
BETADINE
BETAGAN
BETAHISTINE HCL
BETAINE ANHYDROUS
BETAJECT
BETALOC
"
BETALOC DURULES
BETAMETHASONE ACETATE/
BETAMETHASONE SODIUM
PHOSPHATE
BETAMETHASONE
DIPROPIONATE
BETAMETHASONE
DIPROPIONATE/
SALICYLIC ACID
BETAMETHASONE
DIPROPIONATE/CLOTRIMAZOLE
BETAMETHASONE DISODIUM
PHOSPHATE
"
BETAMETHASONE VALERATE
BETASERON (EDS)
BETAXIN
BETAXOLOL HCL
BETHANECHOL CHLORIDE
BETNESOL
BETNESOL ENEMA
BETOPTIC S
BEZAFIBRATE
BEZALIP SR (EDS)
BIAXIN (EDS)
BIAXIN BID (EDS)
BIAXIN XL (EDS)
BILTRICIDE
BIOPRAVASTATIN
BIQUIN DURULES
BISOPROLOL FUMARATE
BLEPHAMIDE S.O.P.
BONAMINE
BOSENTAN
BOTOX (EDS)
BOTULINUM TOXIN TYPE A
BREVICON
BREVICON 1/35
BRICANYL TURBUHALER
BRIMONIDINE TARTRATE
BRINZOLAMIDE
BROMAZEPAM
BROMOCRIPTINE MESYLATE
BUDESONIDE
"
Page
134
159
189
59
198
29
127
198
198
198
198
198
28
31
31
190
184
140
71
210
159
50
51
51
159
189
190
195
134
190
190
214
207
139
28
134
190
139
56
56
7
7
7
2
58
54
47
137
146
211
211
211
164
164
34
139
137
113
211
134
147
PRODUCT NAME
BUDESONIDE
"
BUMETANIDE
BUPROPION HCL
BURINEX (EDS)
BURO-SOL
BURO-SOL-OTIC
BUSCOPAN
BUSERELIN ACETATE
BUSPAR
BUSPIRONE
C.E.S.
CABERGOLINE
CAFERGOT-PB
CALCIFEROL
CALCIMAR (EDS)
CALCIPOTRIOL
CALCITONIN SALMON
CALCITRIOL
CALCIUM POLYSTYRENE
SULFONATE
CALTINE 100 (EDS)
CANDESARTAN CILEXETIL
CANDESARTAN CILEXETIL/
HYDROCHLOROTHIAZIDE
CANDISTATIN
CANESTEN
CANESTEN-3
CANESTEN-6
CAPEX SHAMPOO
CAPOTEN
"
CAPTOPRIL
"
CAPTOPRIL
"
CARBACHOL
CARBAMAZEPINE
CARBOLITH
CARDIZEM
CARDIZEM CD
"
CARDIZEM-SR
CARDURA-1
CARDURA-2
CARDURA-4
CARVEDILOL
CATAPRES
CECLOR (EDS)
CECLOR BID (EDS)
CEFACLOR
CEFIXIME
CEFPROZIL
CEFTIN (EDS)
CEFUROXIME AXETIL
CEFZIL (EDS)
CELEBREX (EDS)
CELECOXIB
CELESTODERM-V
CELESTODERM-V/2
CELESTONE SOLUSPAN
CELEXA
CELLCEPT (EDS)
CELONTIN
CEPHALEXIN MONOHYDRATE
CESAMET (EDS)
Page
159
190
125
95
125
196
133
29
211
116
116
166
211
34
207
173
199
173
207
124
173
59
59
182
181
181
181
181
181
192
60
61
47
60
60
61
138
91
117
48
49
50
49
62
62
62
48
61
5
5
5
5
6
6
6
6
76
76
190
190
159
95
216
91
6
216
342
PRODUCT NAME
CETAMIDE
CHEMSTRIP BG
CHEMSTRIP UG 5000K
CHLORAL HYDRATE
CHLORDIAZEPOXIDE
CHLOROQUINE PHOSPHATE
CHLORPROMAZINE
CHLORPROMAZINE
CHLORPROPAMIDE
CHLORTHALIDONE
CHOLEDYL
CHOLEDYL-SA
CHOLESTYRAMINE RESIN
CHORIONIC GONADOTROPIN
CHRONOVERA
CICLOPIROX OLAMINE
CILAZAPRIL
CILAZAPRIL/
HYDROCHLOROTHIAZIDE
CILOXAN (EDS)
CIMETIDINE
CIPRO (EDS)
CIPRO HC (EDS)
CIPROFLOXACIN
"
CIPROFLOXACIN/
HYDROCORTISONE
CITALOPRAM HYDROBROMIDE
CLARITHROMYCIN
CLAVULIN-125F (EDS)
CLAVULIN-200 (EDS)
CLAVULIN-250 (EDS)
CLAVULIN-250F (EDS)
CLAVULIN-400 (EDS)
CLAVULIN-500 (EDS)
CLAVULIN-875 (EDS)
CLIMARA 100 (EDS)
CLIMARA 50 (EDS)
CLINDAMYCIN HCL
CLINDAMYCIN PALMITATE HCL
CLINDAMYCIN PHOSPHATE
CLINDAMYCIN PHOSPHATE/
BENZOYL PEROXIDE
CLINDOXYL GEL
CLINITEST
CLOBAZAM
CLOBETASONE BUTYRATE
CLOMIPRAMINE HCL
CLONAPAM
CLONAZEPAM
CLONIDINE HCL
CLOPIDOGREL BISULFATE
CLOPIXOL (EDS)
CLOPIXOL ACUPHASE (EDS)
CLOPIXOL DEPOT (EDS)
CLORAZEPATE DIPOTASSIUM
CLOTRIMADERM
CLOTRIMAZOLE
CLOXACILLIN
CLOZAPINE
CLOZARIL (EDS)
CO FLUOXETINE
CODEINE
CODEINE PHOSPHATE
COGENTIN
Page
133
120
121
116
113
18
104
104
171
125
203
203
56
168
71
181
61
61
133
147
19
136
19
133
136
95
7
9
9
9
9
9
9
9
167
167
12
13
180
198
198
121
92
191
191
191
96
90
90
61
43
111
110
110
113
181
181
10
104
104
98
83
83
83
28
PRODUCT NAME
COLCHICINE
COLCHICINE-ODAN
COLESTID
COLESTIPOL HCL RESIN
COMBANTRIN
COMBIVENT
COMBIVIR (EDS)
COMTAN
CONDYLINE
CONJUGATED ESTROGENS/
MEDROXYPROGESTERONE
ACETATE
"
COPAXONE (EDS)
CORDARONE
COREG (EDS)
CORGARD
CORTATE
"
CORTEF
CORTENEMA
CORTIFOAM
CORTIMYXIN
CORTISONE
CORTISONE ACETATE
CORTISPORIN
"
"
CORTODERM
"
CORTONE
COSOPT
COSYNTROPIN ZINC
HYDROXIDE
"
COTAZYM
COTAZYM ECS 20
COTAZYM ECS 8
COUMADIN
"
COVERSYL
COZAAR
CREON 10
CREON 20
CREON 25
CREON 5
CRIXIVAN (EDS)
CROMOLYN
CROTAMITON
CUPRIC SO4 REAGENT
CUPRIMINE
CYANOCOBALAMIN
CYANOCOBALAMIN
CYCLEN
CYCLOBENZAPRINE HCL
CYCLOCORT
CYCLOMEN
CYCLOSPORINE
CYCLOSPORINE (TRANSPLANT)
CYPROTERONE ACETATE
CYSTADANE
CYTOMEL
CYTOTEC
CYTOVENE (EDS)
D.D.A.V.P. (EDS)
DALACIN C
"
Page
211
211
56
56
2
30
16
212
199
166
166
175
213
46
48
51
193
194
161
194
194
137
159
159
136
137
196
193
194
159
139
120
173
145
145
145
41
42
66
65
145
145
146
145
18
140
183
121
156
206
206
165
36
189
162
199
212
24
210
176
149
14
174
12
13
343
PRODUCT NAME
DALACIN T
DALMANE
DALTEPARIN SODIUM
DANAZOL
DANTRIUM
DANTROLENE SODIUM
DARAPRIM
DARVON-N
DELATESTRYL
DELAVIRDINE MESYLATE
DELESTROGEN
DEMEROL
DEMULEN 30
DEPAKENE
DEPEN
DEPO-MEDROL
DEPO-PROVERA
DEPO-TESTOSTERONE
DERMA-SMOOTHE/FS
DERMOVATE
DESFERAL (EDS)
DESIPRAMINE HCL
DESMOPRESSIN
DESOCORT
DESONIDE
DESOXI
DESOXIMETASONE
DESQUAM-X
DESYREL
"
DETROL (EDS)
DEXAMETHASONE
"
DEXAMETHASONE
21-PHOSPHATE
DEXAMETHASONE SODIUM PHO
DEXASONE
DEXEDRINE
DEXTROAMPHETAMINE SO4
DIABETA
DIAMOX SEQUELS
DIARR-EZE
DIASTAT
DIASTIX
DIAZEPAM
DICLECTIN
DICLOFENAC SODIUM
"
DICLOFENAC SODIUM/
MISOPROSTOL
DICYCLOMINE HCL
DIDANOSINE
DIDROCAL
DIDRONEL (EDS)
DIFFERIN
DIFLUCAN
DIFLUCAN (EDS)
DIFLUCAN P.O.S. (EDS)
DIFLUCORTOLONE VALERATE
DIFLUNISAL
DIGOXIN
DIHYDROERGOTAMINE MESYL.
DIHYDROERGOTAMINE
MESYLATE
DIHYDROERGOTAMINE-SANDOZ
DIIODOHYDROXYQUIN
Page
180
114
40
162
36
36
19
88
156
162
15
167
85
163
94
156
161
175
162
192
191
156
96
174
191
191
192
192
198
102
103
202
134
160
160
160
134
160
111
111
171
137
144
114
121
114
146
76
139
77
29
16
212
212
196
3
3
3
192
77
48
34
34
34
2
PRODUCT NAME
DILANTIN
DILAUDID
"
DILAUDID HP-PLUS
DILAUDID-HP
DILAUDID-XP
DILTIAZEM HCL
"
DIMENHYDRINATE
DIMENHYDRINATE IM
DIOCARPINE
DIODEX
DIODOQUIN
DIOPRED
DIOPTIMYD
DIOSULF
DIOVAN
DIOVAN-HCT
DIPENTUM
DIPHENOXYLATE HCL
DIPIVEFRIN HCL
DIPROLENE
DIPROSALIC
DIPROSONE
DIPYRIDAMOLE
DIPYRIDAMOLE/
DISOPYRAMIDE
DITHRANOL
DITROPAN
DIVALPROEX SODIUM
DIXARIT (EDS)
DOM-AMANTADINE
DOM-ATENOLOL
DOM-BACLOFEN
DOM-BROMOCRIPTINE
DOM-BUSPIRONE
DOM-CAPTOPRIL
"
DOM-CEFACLOR (EDS)
DOM-CEPHALEXIN
DOM-CIMETIDINE
DOM-CLONAZEPAM
DOM-CLONAZEPAM-R
DOM-CYCLOBENZAPRINE (EDS)
DOM-DESIPRAMINE
"
DOM-DICLOFENAC
DOM-DICLOFENAC SR
"
DOM-DIVALPOREX
DOM-DIVALPROEX
"
DOM-DOMPERIDONE
DOM-FENOFIBR. MICRO
DOM-FLUOXETINE
DOM-FLUVOXAMINE
"
DOM-GABAPENTIN
DOM-GEMFIBROZIL
DOM-GLYBURIDE
DOM-INDAPAMIDE
DOM-IPRATROPIUM
DOM-LOPERAMIDE
DOM-LORAZEPAM
DOM-LOXAPINE
DOM-MEFENAMIC ACID
Page
91
84
85
85
85
85
48
61
146
146
138
134
2
135
137
133
70
70
149
144
138
189
190
189
71
71
50
198
202
92
61
14
47
36
211
116
60
61
92
5
6
147
90
90
36
96
97
76
76
77
92
92
93
147
56
98
98
99
93
57
171
126
139
144
114
107
79
344
PRODUCT NAME
DOM-METFORMIN
DOM-METOPROLOL
"
DOM-METOPROLOL-L
"
DOM-MOCLOBEMIDE
DOM-NEFAZODONE
DOM-NIFEDIPINE
DOM-NIZATIDINE
DOM-NORTRIPTYLINE
DOM-NYSTATIN
DOM-OXYBUTYNIN
DOMPERIDONE MALEATE
DOM-PINDOLOL
"
DOM-PROCYCLIDINE
DOM-PROPRANOLOL
DOM-RANITIDINE
DOM-SALBUTAMOL
DOM-SALBUTAMOL RESPIR.SOL
DOM-SELEGILINE (EDS)
DOM-SERTRALINE
DOM-SODIUM CROMOGLYCATE
DOM-SOTALOL
DOM-SUCRALFATE
DOM-TEMAZEPAM
DOM-TERAZOSIN
DOM-TIAPROFENIC
DOM-TICLOPIDINE (EDS)
DOM-TIMOLOL
DOM-TRAZODONE
"
DOM-VALPROIC ACID
DOM-VERAPAMIL SR
DONEPEZIL HCL
DORNASE ALFA
DORZOLAMIDE HCL
DORZOLAMIDE HCL/TIMOLOL
MALEATE
DOSTINEX (EDS)
DOVONEX
DOXAZOSIN MESYLATE
DOXEPIN HCL
DOXERCALCIFEROL
DOXYCIN
DOXYCYCLINE
DOXYLAMINE SUCCINATE/
PYRIDOXINE HCL
DRISDOL
DURAGESIC (EDS)
DURALITH
DUVOID
ECONAZOLE NITRATE
ECOSTATIN
EDECRIN (EDS)
EES 200
EES 400
EFAVIRENZ
EFFEXOR
EFFEXOR XR
EFUDEX
ELAVIL
ELDEPRYL (EDS)
ELITE
ELMIRON (EDS)
ELOCOM
ELTROXIN
Page
172
50
51
50
51
12
100
100
52
149
101
4
202
147
52
53
29
54
150
32
33
218
102
219
55
150
115
69
82
43
141
102
103
94
71
212
130
138
139
211
199
62
97
207
11
11
146
207
84
117
28
181
181
125
8
8
15
104
104
200
95
218
120
217
194
176
PRODUCT NAME
EMO-CORT
"
ENALAPRIL MALEATE
ENALAPRIL MALEATE/
HYDROCHLOROTHIAZIDE
ENBREL (EDS)
ENCORE
ENDANTADINE
ENOXAPARIN
ENTACAPONE
ENTOCORT
ENTOCORT (EDS)
ENTROPHEN
EPINEPHRINE
EPINEPHRINE HCL
EPIPEN
EPIPEN JR.
EPIVAL
"
EPOETIN ALFA
EPREX (EDS)
EPROSARTAN MESYLATE
ERGAMISOL (EDS)
ERGOTAMINE TARTRATE/
CAFFEINE/
BELLADONNA ALKALOIDS/
PENTOBARBITAL
ERYC
ERYTHROMYCIN BASE
ERYTHROMYCIN ESTOLATE
ERYTHROMYCIN
ETHYLSUCCINATE
ERYTHROMYCIN
ETHYLSUCCINATE/
SULFISOXAZOLE ACETATE
ERYTHROMYCIN STEARATE
ERYTHROMYCIN/ETHYL
ALCOHOL
ESDEPALLATHRIN/PIPERONYL
BUTOXIDE
ESTALIS (EDS)
ESTALIS-SEQUI (EDS)
ESTRACE
ESTRACOMB (EDS)
ESTRADERM (EDS)
ESTRADIOL
ESTRADIOL & NORETHINDRONE
ACETATE/ESTRADIOL
"
ESTRADIOL VALERATE
ESTRADIOL/NORETHINDRONE
ACETATE
"
ESTRADOT (EDS)
ESTRING
ESTROGEL (EDS)
ESTROPIPATE
ETANERCEPT
ETHACRYNIC ACID
ETHINYL ESTRADIOL/
DESOGESTREL
ETHINYL ESTRADIOL/
D-NORGESTREL
ETHINYL ESTRADIOL/
ETHYNODIOL DIACETATE
ETHINYL ESTRADIOL/
L-NORGESTREL
ETHINYL ESTRADIOL/
Page
193
194
62
62
212
120
14
40
212
190
147
76
30
31
30
30
92
93
42
42
63
215
34
7
7
7
8
21
8
180
183
167
167
166
167
167
166
167
175
167
167
175
167
166
166
168
212
125
163
163
163
163
345
PRODUCT NAME
NORETHINDRONE
ETHINYL ESTRADIOL/
NORETHINDRONE ACETATE
ETHINYL ESTRADIOL/
NORGESTIMATE
ETHOPROPAZINE
ETHOSUXIMIDE
ETIDRONATE DISODIUM
ETIDRONATE DISODIUM/
CALCIUM CARBONATE
ETODOLAC
EUGLUCON
EUMOVATE
EURAX
EVISTA (EDS)
EXDOL-30
EXELON (EDS)
FAMCICLOVIR
FAMOTIDINE
FAMVIR
FASTTAKE
FELDENE
FELODIPINE
FENOFIBRATE
FENOPROFEN
FENOTEROL HYDROBROMIDE
FENTANYL
FILGRASTIM
FINASTERIDE
FLAGYL
"
FLAREX
FLAVOXATE HCL
FLECAINIDE ACETATE
FLEXERIL (EDS)
FLOCTAFENINE
FLOMAX
FLONASE
FLORINEF
FLOVENT
FLOVENT DISKUS
FLOVENT HFA
FLUANXOL
FLUANXOL DEPOT
FLUCONAZOLE
FLUDROCORTISONE ACETATE
FLUNARIZINE HCL
FLUNISOLIDE
FLUOCINOLONE ACETONIDE
FLUOCINONIDE
FLUODERM
FLUOROMETHOLONE
FLUOROMETHOLONE ACETATE
FLUOROURACIL
FLUOTIC
FLUOXETINE
FLUPENTHIXOL
DIHYDROCHLORIDE
FLUPHENAZINE DECANOATE
FLUPHENAZINE ENANTHATE
FLUPHENAZINE HCL
FLURAZEPAM HCL
FLURBIPROFEN
FLURBIPROFEN SODIUM
"
FLUVASTATIN SODIUM
Page
164
164
165
28
91
212
212
77
171
191
183
168
82
218
14
148
14
120
81
63
56
77
31
84
43
212
21
184
135
202
50
36
89
219
135
160
160
160
160
105
105
3
160
34
135
192
193
192
135
135
200
219
98
105
105
105
105
105
114
78
135
135
160
57
PRODUCT NAME
Page
FLUVOXAMINE MALEATE
FML
FOLIC ACID
FORADIL (EDS)
FORMOTEROL FUMARATE
FORMOTEROL FUMARATE
DIHYDRATE/BUDESONIDE
FORMULEX
FORTOVASE (EDS)
FOSAMAX (EDS)
FOSFOMYCIN TROMETHAMINE
FOSINOPRIL
FRAGMIN (EDS)
FRAMYCETIN SO4
FRAMYCETIN SO4/
GRAMICIDIN/DEXAMETHASONE BAS
FRAXIPARINE (EDS)
FRAXIPARINE FORTE (EDS)
FREESTYLE
FRISIUM
FUCIDIN
FUCIDIN H
FUCITHALMIC (EDS)
FULVICIN U/F
FUROSEMIDE
FUSIDIC ACID
"
FUSIDIC ACID/
GABAPENTIN
GALANTAMINE HYDROBROMIDE
GAMMA-BENZENE
HEXACHLORIDE
GANCICLOVIR SO4
GARAMYCIN
"
GARASONE
GATIFLOXACIN
GEMFIBROZIL
GEN-ACEBUTOLOL
GEN-ACYCLOVIR
"
GEN-ALPRAZOLAM
GEN-AMANTADINE
GEN-AMOXICILLIN
GEN-ATENOLOL
GEN-AZATHIOPRINE
GEN-BACLOFEN
GEN-BECLO AQ.
GEN-BROMAZEPAM
GEN-BUDESONIDE AQ
GEN-BUSPIRONE
GEN-CAPTOPRIL
"
GEN-CIMETIDINE
GEN-CLOBETASOL
GEN-CLOMIPRAMINE
GEN-CLONAZEPAM
GEN-CYCLOBENZAPRINE (EDS)
GEN-CYPROTERONE (EDS)
GEN-DILTIAZEM
GEN-DOXAZOSIN
GEN-FAMOTIDINE
GEN-FENOFIBR. MICRO
GEN-FLUCONAZOLE
98
135
206
31
31
31
29
18
210
20
63
40
180
136
41
41
120
92
180
195
132
3
125
132
180
195
93
213
183
14
3
132
136
19
57
46
46
13
14
112
14
8
47
210
36
134
113
134
116
60
61
92
147
191
96
90
36
24
48
62
148
56
3
3
346
PRODUCT NAME
GEN-FLUOXETINE
GEN-GEMFIBROZIL
GEN-GLYBE
GEN-INDAPAMIDE
GEN-IPRATROPIUM
GEN-LOVASTATIN
GEN-MEDROXY
GEN-METFORMIN
GEN-METOPROLOL
"
"
GEN-NABUMETONE (EDS)
GEN-NEFAZODONE
GEN-NITRO SL SPRAY
GEN-NIZATIDINE
GEN-NORTRIPTYLINE
GEN-OXYBUTYNIN
GEN-PINDOLOL
"
GEN-PIROXICAM
GEN-PROPAFENONE
GEN-RANITIDINE
GEN-SALBUTAMOL RESPIR.SOL
"
GEN-SELEGILINE (EDS)
GEN-SERTRALINE
GEN-SOTALOL
GENTAMICIN
GENTAMICIN SO4
"
GENTAMICIN SO4
GENTAMICIN SO4/
BETAMETHASONE SODIUM
PHOSPHATE
GENTAMICIN SULFATE
GENTAMICIN SULPHATE
GEN-TEMAZEPAM
GEN-TERBINAFINE
GEN-TICLOPIDINE (EDS)
GEN-TIMOLOL
GEN-TRAZODONE
"
GEN-TRIAZOLAM
GEN-VALPROIC
GEN-VERAPAMIL
GEN-VERAPAMIL SR
GEN-WARFARIN
"
GLATIRAMER ACETATE
GLUCAGON
GLUCAGON
GLUCOFILM
GLUCONORM (EDS)
GLUCOPHAGE
GLUCOSE OXIDASE/
PEROXIDASE REAGENT
"
GLUCOSE OXIDASE/
PEROXIDASE/SODIUM
NITROFERRICYANIDE/
GLYCINE REAGENT
GLUCOSE OXIDASE/
PEROXIDASE/SODIUM
NITROPRUSSIDE REAGENT
GLUCOSTIX
Page
98
57
171
126
30
57
175
172
50
51
50
51
12
80
100
73
149
101
202
52
53
81
53
150
33
32
33
218
102
55
3
3
132
132
136
132
3
115
4
43
141
102
103
115
94
70
71
41
42
213
213
213
120
173
172
120
121
121
121
120
PRODUCT NAME
GLYBURIDE
GLYCON
GOSERELIN ACETATE
GRAVOL
GRISEOFULVIN (ULTRA-FINE)
HALCINONIDE
HALCION
HALOBETASOL PROPIONATE
HALOG
HALOPERIDOL
HALOPERIDOL
HALOPERIDOL DECANOATE
HALOPERIDOL LA
HECTOROL (EDS)
HEPALEAN
HEPARIN
HEPTOVIR (EDS)
HEXACHLOROPHENE
HEXIT SHAMPOO
HIVID (EDS)
HOMATROPINE HYDROBROMIDE
HP-PAC (EDS)
HUMALOG (EDS)
HUMALOG CARTRIDGE (EDS)
HUMALOG MIX25 (EDS)
HUMATROPE (EDS)
HUMULIN 30/70
HUMULIN-L
HUMULIN-N
HUMULIN-N CARTRIDGE
HUMULIN-R
HUMULIN-R CARTRIDGE
HUMULIN-U
HYCORT
HYDERM
HYDRALAZINE HCL
HYDROCHLOROTHIAZIDE
HYDROCORTISONE
"
HYDROCORTISONE SODIUM
SUCCINATE
HYDROCORTISONE VALERATE
HYDROCORTISONE/UREA
HYDRODIURIL
HYDROMORPH CONTIN
HYDROMORPHONE HCL
HYDROMORPHONE HCL
HYDROMORPHONE HP 10
HYDROMORPHONE HP 20
HYDROMORPHONE HP 50
HYDROVAL
HYDROXYBUTYRATE
DEHYDROGENASE
HYDROXYCHLOROQUINE SO4
HYDROXYZINE
HYTRIN
HYTRIN STARTER PACK
HYZAAR
HYZAAR DS
IBUPROFEN
IDARAC
Page
171
172
213
146
3
193
115
193
193
106
106
106
106
106
207
40
40
16
184
183
17
139
148
170
170
170
174
174
170
170
170
169
169
169
169
169
170
194
193
63
125
161
193
194
193
161
194
194
125
84
84
84
85
85
85
194
120
19
116
29
69
69
65
65
78
89
347
PRODUCT NAME
IMDUR
IMIPRAMINE
IMITREX (EDS)
IMODIUM
IMURAN
INDAPAMIDE
INDAPAMIDE HEMIHYDRATE
INDERAL
INDERAL-LA
INDINAVIR SO4
INDOCID
INDOMETHACIN
INFLAMASE FORTE
INFLAMASE MILD
INFLIXIMAB
INFUFER (EDS)
INHIBACE
INHIBACE PLUS
INNOHEP (EDS)
INSULIN (ISOPHANE) HUMAN
BIOSYNTHETIC
INSULIN (ISOPHANE) PORK
INSULIN (LENTE) HUMAN
BIOSYNTHETIC
INSULIN (LENTE) PORK
INSULIN (REGULAR) ASPART
INSULIN (REGULAR) HUMAN
BIOSYNTHETIC
INSULIN (REGULAR) LISPRO
INSULIN (REGULAR) PORK
INSULIN (REGULAR/ISOPHANE)
HUMAN BIOSYNTHETIC
INSULIN (REGULAR/
PROTAMINE) LISPRO
INSULIN (ULTRALENTE)
HUMAN BIOSYNTHETIC
INTAL
INTAL SPINCAPS
INTERFERON ALFA-2A
INTERFERON ALFA-2B
INTERFERON ALFA-2B/
RIBAVIRIN
INTERFERON BETA-1A
INTERFERON BETA-1B
INTRON-A (EDS)
INVIRASE (EDS)
IODOCHLORHYDROXYQUIN/
FLUMETHASONE PIVALATE
IOPIDINE
IPRATROPIUM BROMIDE
"
IPRATROPIUM BROMIDE/
SALBUTAMOL SO4
IRBESARTAN
IRBESARTAN/
HYDROCHLOROTHIAZIDE
IRON DEXTRAN
ISOPTIN
ISOPTIN SR
ISOPTO ATROPINE
ISOPTO CARBACHOL
ISOPTO CARPINE
ISOPTO HOMATROPINE
ISOSORBIDE DINITRATE
ISOSORBIDE-5 MONONITRATE
ISOTRETINOIN
"
Page
72
99
35
144
210
126
126
54
54
18
79
78
136
136
213
40
61
61
41
169
168
169
169
169
169
170
169
170
170
170
219
219
24
24
213
214
214
24
18
136
139
30
139
30
64
64
40
70
71
138
138
138
139
72
72
196
200
PRODUCT NAME
ISOTREX
ITRACONAZOLE
K-10
KADIAN
KALETRA (EDS)
KAYEXALATE
K-DUR
KEMADRIN
KENACOMB
KENACOMB MILD
KENALOG
KENALOG 10
KENALOG 40
KENALOG-ORABASE
KETO DIASTIX
KETOCONAZOLE
"
KETODERM
KETOPROFEN
KETOROLAC TROMETHAMINE
KETOSTIX
KETOTIFEN FUMARATE
K-LOR
K-LYTE/CL
KWELLADA-P CREME RINSE
KWELLADA-P LOTION
LABETALOL HCL
LACTULOSE
LAMICTAL
LAMISIL
"
LAMIVUDINE
LAMOTRIGINE
LANOXIN
LANSOPRAZOLE
LANSOPRAZOLE/
CLARITHROMYCIN/AMOXICILLIN
LARGACTIL
LASIX
LATANOPROST
LECTOPAM
LEFLUNOMIDE
LENTE ILETIN II, PORK
LESCOL
LEUCOVORIN (EDS)
LEUCOVORIN CALCIUM
(FOLINIC ACID)
LEUPROLIDE ACETATE
LEVAMISOLE
LEVAQUIN (EDS)
LEVOBUNOLOL HCL
LEVOBUNOLOL HCL/
DIPIVEFRIN HCL
LEVOCABASTINE
HYDROCHLORIDE
LEVODOPA/BENZERAZIDE
LEVODOPA/CARBIDOPA
LEVOFLOXACIN
LEVONORGESTREL
LEVOTHYROXINE (SODIUM)
LIDEMOL
LIDEX
LIN-AMOX
"
LIN-BUSPIRONE
LINEZOLID
LIN-MEGESTROL (EDS)
Page
196
4
124
86
18
124
124
29
195
195
195
162
162
195
121
4
181
181
79
135
121
214
124
124
183
183
64
144
93
4
182
16
16
93
48
148
148
104
125
139
113
214
169
57
206
206
214
215
19
140
140
140
215
215
19
165
176
193
193
8
9
116
13
25
348
PRODUCT NAME
LIN-NEFAZODONE
LIN-PRAVASTATIN
LINSOTALOL
LIORESAL
LIORESAL-DS
LIOTHYRONINE (SODIUM)
LIPIDIL-MICRO
LIPITOR
LISINOPRIL
LISINOPRIL/
HYDROCHLOROTHIAZIDE
LITHIUM CARBONATE
LIVOSTIN
LOCACORTEN-VIOFORM
LODOXAMIDE TROMETHAMINE
LOESTRIN 1.5/30
LOMOTIL
LONITEN (EDS)
LOPERACAP
LOPERAMIDE HCL
LOPID
LOPINAVIR/RITONAVIR
LOPRESOR
"
LOPRESOR-SR
LOPROX
LORAZEPAM
LOSARTAN POTASSIUM
LOSARTAN POTASSIUM/
HYDROCHLOROTHIAZIDE
LOSEC (EDS)
LOTENSIN
LOTRIDERM
LOVASTATIN
LOVENOX (EDS)
LOXAPINE SUCCINATE
LOZIDE
LUPRON DEPOT (EDS)
LUVOX
"
LYDERM
M.O.S.
"
"
M.O.S.-S.R.
MACROBID
MACRODANTIN
MANDELAMINE
MANERIX
MAPROTILINE
MARVELON
MAVIK
MAXALT (EDS)
MAXALT RPD (EDS)
MAXIDEX
MAXITROL
MEBENDAZOLE
MECLIZINE HCL
MED FLUOXETINE
MED-ACEBUTOLOL
MED-ALPRAZOLAM
MED-AMANTADINE
MED-AMOXICILLIN
MED-ATENOLOL
MED-BACLOFEN
MED-BECLOMETHASONE AQ
Page
100
58
55
36
36
36
176
56
56
64
65
117
140
136
140
164
144
66
144
144
57
18
50
51
51
181
114
65
65
149
59
195
57
40
107
126
214
98
99
193
85
86
87
86
20
20
20
100
99
163
70
35
35
134
137
2
146
98
46
46
112
14
8
47
36
134
PRODUCT NAME
MED-BROMAZEPAM
MED-BUSPIRONE
MED-CAPTOPRIL
"
MED-CLOMIPRAMINE
MED-CLONAZEPAM
MED-CYCLOBENZAPRINE (EDS)
MED-DILTIAZEM
MED-GEMFIBROZIL
MED-GLYBURIDE
MED-METFORMIN
MED-METOPROLOL
"
MED-PINDOLOL
"
MED-RANITIDINE
MEDROL
MEDROXYPROGESTERONE
ACETATE
MED-SALBUTAMOL
MED-SELEGILINE (EDS)
MED-SOTALOL
MED-TEMAZEPAM
MED-TIMOLOL
MED-VALPROIC
MED-VERAPAMIL
MEFENAMIC ACID
MEGACE (EDS)
MEGACE OS (EDS)
MEGESTROL
MELOXICAM
MEPERIDINE HCL
MEPRON (EDS)
MERCAPTOPURINE
MESASAL
M-ESLON
"
MESTINON
MESTRANOL/NORETHINDRONE
METFORMIN
METFORMIN
METHENAMINE MANDELATE
METHIMAZOLE
METHOTREXATE
METHOTRIMEPRAZINE
METHOXSALEN
METHSUXIMIDE
METHYLDOPA
METHYLDOPA/
HYDROCHLOROTHIAZIDE
METHYLPHENIDATE HCL
METHYLPREDNISOLONE
METHYLPREDNISOLONE
ACETATE
METHYSERGIDE MALEATE
METOCLOPRAMIDE HCL
METOLAZONE
METOPROLOL TARTRATE
"
METROCREAM
METROGEL
METRONIDAZOLE
"
MEVACOR
MEXILETINE HCL
MIACALCIN (EDS)
Page
113
116
60
61
96
90
36
48
57
171
172
50
51
12
52
53
150
161
175
32
218
55
115
141
94
70
79
25
25
25
80
85
85
21
25
151
86
87
28
165
172
172
20
177
199
117
200
91
65
65
111
161
161
34
148
126
50
66
184
184
21
184
57
51
173
349
PRODUCT NAME
MICARDIS
MICARDIS PLUS
MICATIN
MICONAZOLE 3 DAY OVULE
MICONAZOLE NITRATE
MICRO-K EXTENCAPS
MICRONOR
MIDAMOR
MIDODRINE HCL
MIGRANAL
MINESTRIN 1/20
MINIPRESS
MINITRAN 0.2
MINITRAN 0.4
MINITRAN 0.6
MINOCIN (EDS)
MINOCYCLINE HCL
MIN-OVRAL
MINOXIDIL
MIOCARPINE
MIRAPEX
MIRENA
MIRTAZAPINE
MISOPROSTOL
MOBICOX (EDS)
MOCLOBEMIDE
MODAFINIL
MODECATE
MODECATE CONCENTRATE
MODITEN
MODITEN ENANTHATE
MODURET
MOGADON
MOMETASONE FUROATE
MOMETASONE FUROATE
MONOHYDRATE
MONISTAT-3
MONISTAT-7
MONITAN
MONOCOR (EDS)
MONOPRIL
MONTELUKAST SODIUM
MONUROL (EDS)
MORPHINE
MORPHINE HP 50
MORPHINE SO4
MORPHINE SULPHATE
MOS-SULFATE
"
MOTRIN
MOXIFLOXACIN HCL
MS CONTIN
"
"
MSIR
"
"
"
MUCOMYST
MUPIROCIN
MYCOBUTIN (EDS)
MYCOPHENOLATE MOFETIL
MYCOSTATIN
"
MYOCHRYSINE
Page
68
68
182
182
182
124
165
126
31
34
164
67
72
72
72
12
12
163
66
138
217
165
99
149
80
99
111
105
105
105
105
59
90
194
135
182
182
182
182
46
47
63
215
20
85
87
87
87
85
86
78
20
86
87
88
76
85
86
87
88
130
180
217
216
4
182
154
PRODUCT NAME
MYSOLINE
NABILONE
NABUMETONE
NADOLOL
"
NADROPARIN CALCIUM
NAFARELIN ACETATE
NALCROM (EDS)
NALFON
NAPROSYN
NAPROSYN-S.R.
NAPROXEN
NAPROXEN
NARATRIPTAN HCL
NARDIL
NASACORT AQ
NASONEX
NATEGLINIDE
NAVANE
NEDOCROMIL SO4
NEFAZODONE
NELFINAVIR MESYLATE
NEMBUTAL
NEOMYCIN/
GRAMICIDIN/NYSTATIN/
NEORAL (EDS)
"
NEOSPORIN
"
NEOSTIGMINE BROMIDE
NERISONE
NEULEPTIL
NEUPOGEN (EDS)
NEURONTIN
NEVIRAPINE
NIACIN
NIACIN
NIDAGEL
NIFEDIPINE
"
NIMODIPINE
NIMOTOP (EDS)
NITOMAN
NITRAZADON
NITRAZEPAM
NITRO-DUR 0.2
NITRO-DUR 0.4
NITRO-DUR 0.6
NITRO-DUR 0.8
NITROFURANTOIN
NITROFURANTOIN
MONOHYDRATE
NITROGLYCERIN
NITROL
NITROLINGUAL PUMPSPRAY
NITROSTAT
NIX CREME RINSE
NIX DERMAL CREAM
NIZATIDINE
NIZORAL
NIZORAL (EDS)
NORETHINDRONE
NORFLOXACIN
"
NORITATE
NOROXIN (EDS)
"
Page
89
216
80
51
66
41
216
219
77
81
80
80
81
34
101
136
135
172
110
216
100
18
112
195
199
212
132
180
28
192
108
43
93
15
206
206
184
52
66
72
72
219
90
90
72
72
72
73
20
20
72
73
73
73
183
183
149
181
4
165
20
134
184
20
134
350
PRODUCT NAME
NORPACE-CR
NORPLANT
NORPRAMIN
"
NORTRIPTYLINE
NORVASC
NORVIR (EDS)
NORVIR SEC (EDS)
NOVAMILOR
NOVAMOXIN
"
NOVASEN
NOVO-5-ASA
NOVO-ACEBUTOLOL
NOVO-ALPRAZOL
NOVO-AMPICILLIN
NOVO-ATENOL
NOVO-AZATHIOPRINE
NOVO-BROMAZEPAM
NOVO-BUSPIRONE
NOVO-CAPTORIL
"
NOVO-CARBAMAZ
NOVO-CEFACLOR (EDS)
NOVO-CHLOROQUINE
NOVO-CHLORPROMAZINE
NOVO-CHOLAMINE
NOVO-CHOLAMINE LIGHT
NOVO-CIMETINE
NOVO-CLINDAMYCIN
NOVO-CLOBAZAM
NOVO-CLOBETASOL
NOVO-CLONAZEPAM
NOVO-CLONIDINE
NOVO-CLOPAMINE
NOVO-CLOPATE
NOVO-CLOXIN
NOVO-CYCLOPRINE (EDS)
NOVO-CYPROTERONE (EDS)
NOVO-DESIPRAMINE
"
NOVO-DIFENAC
"
NOVO-DIFENAC SR
"
NOVO-DIFLUNISAL
NOVO-DILTAZEM
NOVO-DILTAZEM CD
"
NOVO-DILTAZEM SR
NOVO-DIMENATE
NOVO-DIVALPROEX
"
NOVO-DOMPERIDONE
NOVO-DOXAZOSIN
NOVO-DOXEPIN
NOVO-DOXYLIN
NOVO-FAMOTIDINE
NOVO-FENOFIB. MICRO
NOVO-FLUOXETINE
NOVO-FLURPROFEN
NOVO-FLUVOXAMINE
"
NOVO-FURANTOIN
NOVO-GABAPENTIN
NOVO-GEMFIBROZIL
NOVO-GESIC C15
NOVO-GESIC C30
Page
50
165
96
97
101
47
18
18
59
8
9
76
151
46
112
10
47
210
113
116
60
61
92
5
18
104
56
56
147
12
92
191
90
61
96
113
10
36
24
96
97
76
77
76
77
77
48
49
50
49
146
92
93
147
62
97
11
148
56
98
78
98
99
20
93
57
82
82
PRODUCT NAME
NOVO-GLUCOSE
NOVO-GLYBURIDE
NOVO-HYDRAZIDE
NOVO-HYDROXYZIN
NOVO-HYLAZIN
NOVO-INDAPAMIDE
NOVO-IPRAMIDE
NOVO-KETO
NOVO-KETOCONAZOLE (EDS)
NOVO-LEVOBUNOLOL
NOVO-LEVOCARBIDOPA
NOVO-LEXIN
NOVOLIN GE 30/70
NOVOLIN GE LENTE
NOVOLIN GE NPH
NOVOLIN GE NPH PENFILL
NOVOLIN GE TORONTO
NOVOLIN GE TORONTO PENFIL
NOVOLIN GE ULTRALENTE
NOVO-LOPERAMIDE
NOVO-LORAZEM
NOVO-MAPROTILINE
NOVO-MEDRONE
NOVO-MEPRAZINE
NOVO-METFORMIN
NOVO-METHACIN
"
NOVO-METOPROL
"
"
NOVO-MEXILETINE
NOVO-MISOPROSTOL
NOVO-MOCLOBEMIDE
"
NOVO-NADOLOL
NOVO-NAPROX
NOVO-NAPROX SR
NOVO-NIDAZOL
NOVO-NIFEDIN
NOVO-NIZATIDINE
NOVO-NORFLOXACIN (EDS)
NOVO-NORTRIPTYLINE
NOVO-OXYBUTYNIN
NOVO-PEN-VK
NOVO-PERIDOL
NOVO-PINDOL
"
NOVO-PIROCAM
NOVO-PRANOL
NOVO-PRAZIN
NOVO-PREDNISONE
NOVO-PROFEN
NOVO-PROPAMIDE
NOVO-PUROL
NOVO-QUININE
NOVO-RANIDINE
NOVORAPID (EDS)
Page
120
171
125
116
63
126
30
79
4
214
140
215
6
170
170
170
170
170
170
169
169
169
169
169
170
144
114
99
175
117
172
78
79
50
51
50
51
51
12
149
99
100
80
51
80
80
21
52
149
20
101
202
10
106
52
53
81
54
67
161
78
171
210
19
150
169
7
8
351
PRODUCT NAME
NOVO-SALMOL
NOVO-SELEGILINE (EDS)
NOVO-SEMIDE
NOVO-SERTRALINE
NOVO-SORBIDE
NOVO-SOTALOL
NOVO-SPIROTON
NOVO-SPIROZINE
NOVO-SUCRALATE
NOVO-SUNDAC
NOVO-TEMAZEPAM
NOVO-TERAZOSIN
NOVO-TERBINAFINE
NOVO-THEOPHYL SR
NOVO-TIAPROFENIC
NOVO-TIMOL
"
NOVO-TRAZODONE
"
NOVO-TRIAMZIDE
NOVO-TRIMEL
"
NOVO-TRIMEL DS
NOVO-TRIOLAM
NOVO-TRIPRAMINE
NOVO-VALPROIC
NOVO-VERAMIL
NOVO-VERAMIL SR
NOZINAN
NPH ILETIN II PORK
NU-ACEBUTOLOL
NU-ACYCLOVIR
"
NU-ALPRAZ
NU-AMILZIDE
NU-AMOXI
"
NU-AMPI
NU-ATENOL
NU-BACLO
NU-BECLOMETHASONE
NU-BROMAZEPAM
NU-BUSPIRONE
NU-CAPTO
"
NU-CARBAMAZEPINE
NU-CEFACLOR (EDS)
NU-CEPHALEX
NU-CIMET
NU-CLONAZEPAM
NU-CLONIDINE
NU-CLOXI
NU-COTRIMOX
"
NU-COTRIMOX DS
NU-CROMOLYN
NU-CYCLOBENZAPRINE (EDS)
NU-DESIPRAMINE
"
NU-DICLO
NU-DICLO-SR
"
NU-DIFLUNISAL
NU-DILTIAZ
NU-DILTIAZ-CD
NU-DIVALPROEX
"
NU-DOMPERIDONE
Page
32
218
125
102
72
55
126
68
150
82
115
69
4
203
82
55
141
102
103
70
21
22
22
115
103
94
70
71
117
168
46
13
14
112
59
8
9
10
47
36
134
113
116
60
61
92
5
6
147
90
61
10
21
22
22
219
36
96
97
76
76
77
77
48
49
92
93
147
PRODUCT NAME
NU-DOXYCYCLINE
NU-ERYTHROMYCIN-S
NU-FAMOTIDINE
NU-FLUOXETINE
NU-FLURBIPROFEN
NU-FLUVOXAMINE
"
NU-GEMFIBROZIL
NU-GLYBURIDE
NU-HYDRAL
NU-IBUPROFEN
NU-INDAPAMIDE
NU-INDO
"
NU-IPRATROPIUM
NU-KETOCON (EDS)
NU-KETOTIFEN (EDS)
NU-LEVOCARB
NU-LORAZ
NU-LOXAPINE
NU-MEDOPA
NU-MEFENAMIC
NU-MEGESTROL (EDS)
NU-METFORMIN
NU-METOCLOPRAMIDE
NU-METOP
"
NU-MOCLOBEMIDE
"
NU-NAPROX
NU-NIFED
NU-NIFEDIPINE-PA
NU-NORTRIPTYLINE
NU-OXYBUTYN
NU-PENTOXIFYLLINE-SR
NU-PEN-VK
NU-PINDOL
"
NU-PIROX
NU-PRAVASTATIN
NU-PRAZO
NU-PROCHLOR
NU-PROPRANOLOL
NU-RANIT
NU-SALBUTAMOL
"
NU-SELEGILINE (EDS)
NU-SOTALOL
NU-SUCRALFATE
NU-SULFINPYRAZONE
NU-SULINDAC
NU-TEMAZEPAM
NU-TERAZOSIN
NU-TETRA
NU-TIAPROFENIC
NU-TICLOPIDINE (EDS)
NU-TIMOLOL
NU-TRAZODONE
"
NU-TRIAZIDE
NU-TRIMIPRAMINE
NUTROPIN (EDS)
NUTROPIN AQ (EDS)
NU-VALPROIC
NU-VERAP
NYADERM
NYSTATIN
"
Page
11
8
148
98
78
98
99
57
171
63
78
126
78
79
30
4
214
215
114
107
65
79
25
172
148
50
51
99
100
80
52
52
101
202
43
10
52
53
81
58
67
108
54
150
32
33
218
55
150
127
82
115
69
12
82
43
55
102
103
70
103
174
174
94
70
182
4
182
352
PRODUCT NAME
OCTOSTIM (EDS)
OCTREOTIDE
OCUFEN (EDS)
OCUFLOX (EDS)
OESCLIM (EDS)
OFLOXACIN
OGEN
OLANZAPINE
OLSALAZINE SODIUM
OMEPRAZOLE
ONE TOUCH
ONE TOUCH ULTRA
ONE-ALPHA (EDS)
OPTIMYXIN PLUS
ORACORT DENTAL PASTE
ORAP
ORCIPRENALINE SO4
ORTHO 0.5/35
ORTHO 1/35
ORTHO 7/7/7
ORTHO-CEPT
ORTHO-NOVUM 1/50
ORUDIS
ORUDIS SR
ORUDIS-E
OSTOFORTE
OVRAL
OXAZEPAM
OXPRENOLOL HCL
OXSORALEN (EDS)
OXSORALEN ULTRA (EDS)
OXTRIPHYLLINE
OXYBUTYN
OXYBUTYNIN CHLORIDE
OXYCODONE HCL
OXYCONTIN
OXYDERM
OXY-IR
PAMIDRONATE DISODIUM
PANCREASE
PANCREASE MT 10
PANCREASE MT 16
PANCREASE MT 4
PANCRELIPASE (LIPASE/
AMYLASE/PROTEASE)
PANECTYL
PANOXYL
PANOXYL AQUAGEL
PANOXYL-10
PANOXYL-15
PANOXYL-20
PANTOLOC (EDS)
PANTOPRAZOLE
PARIET (EDS)
PARLODEL
PARNATE
PAROXETINE HCL
PARSITAN
PAXIL
PCE
PEDIAPRED
PEDIAZOLE
PEGINTERFERON ALFA-2B
PEG-INTRON (EDS)
PENICILLAMINE
PENICILLIN V (BENZATHINE)
Page
174
216
135
134
167
134
168
107
149
149
120
120
207
132
195
108
31
164
164
164
163
165
79
79
79
207
163
115
31
66
200
200
203
202
202
88
88
198
88
217
217
145
145
145
145
145
219
198
198
198
198
198
149
149
149
211
102
101
28
101
7
161
21
25
25
156
10
PRODUCT NAME
PENICILLIN V (POTASSIUM)
PENTASA
PENTAZOCINE
PENTOBARBITAL SODIUM
PENTOSAN POLYSULFATE SO4
PENTOXIFYLLINE
PEN-VEE
PEPCID
PERGOLIDE MESYLATE
PERICYAZINE
PERINDOPRIL ERBUMINE
PERMAX
PERMETHRIN
PERPHENAZINE
PERSANTINE (EDS)
PETHIDINE
PHENAZO
PHENAZOPYRIDINE
PHENELZINE SO4
PHENOBARBITAL
"
PHENYLBUTAZONE
PHENYTOIN
PHISOHEX
PHYLLOCONTIN
PHYLLOCONTIN-350
PILOCARPINE HCL
PILOPINE-HS
PIMOZIDE
PINDOLOL
"
PINDOLOL/
HYDROCHLOROTHIAZIDE
PIOGLITAZONE HCL
PIPORTIL L4
PIPOTIAZINE PALMITATE
PIROXICAM
PIVMECILLINAM HCL
PIZOTYLINE HYDROGEN
MALATE
PLAN B
PLAQUENIL
PLAVIX (EDS)
PLENDIL
PMS-AMANTADINE
PMS-ATENOLOL
PMS-BACLOFEN
PMS-BENZTROPINE
PMS-BEZAFIBRATE (EDS)
PMS-BROMOCRIPTINE
PMS-BUSPIRONE
PMS-CAPTOPRIL
"
PMS-CEFACLOR (EDS)
PMS-CEPHALEXIN
PMS-CHLORAL HYDRATE SYRUP
PMS-CHOLESTYRAMINE
PMS-CHOLESTYRAMINE LIGHT
PMS-CIMETIDINE
PMS-CLOBETASOL
PMS-CLONAZEPAM
PMS-CLONAZEPAM-R
PMS-CYCLOBENZAPRINE (EDS)
PMS-DESIPRAMINE
"
Page
10
151
89
112
217
43
10
148
217
108
66
217
183
108
71
85
196
196
101
89
112
81
91
184
202
202
138
138
108
52
66
66
172
108
108
81
11
34
165
19
43
63
14
47
36
28
56
211
116
60
61
92
5
6
116
56
56
147
191
90
90
166
36
156
96
97
353
PRODUCT NAME
PMS-DESONIDE
PMS-DEXAMETHASONE
PMS-DEXAMETHASONE SOD PHO
PMS-DICLOFENAC
"
PMS-DICLOFENAC-SR
"
PMS-DIPIVEFRIN
PMS-DIVALPROEX
"
PMS-DOMPERIDONE
PMS-DOXAZOSIN
PMS-FENOFIBR. MICRO
PMS-FLUOROMETHOLONE
PMS-FLUOXETINE
PMS-FLUVOXAMINE
"
PMS-GABAPENTIN
PMS-GEMFIBROZIL
PMS-GENTAMICIN
PMS-GENTAMYCIN
PMS-GLYBURIDE
PMS-HALOPERIDOL
PMS-HYDROMORPHONE
PMS-HYDROXYZINE
PMS-INDAPAMIDE
PMS-IPRATROPIUM
"
PMS-KETOPROFEN
PMS-KETOPROFEN-EC
PMS-KETOTIFEN (EDS)
PMS-LACTULOSE (EDS)
PMS-LEVOBUNOLOL
PMS-LINDANE
PMS-LOPERAMIDE
PMS-LOPERAMIDE HCL
PMS-LORAZEPAM
PMS-LOVASTATIN
PMS-LOXAPINE
PMS-MEFENAMIC ACID
PMS-METFORMIN
PMS-METHYLPHENIDATE
PMS-METOCLOPRAMIDE
PMS-METOPROLOL-B
"
PMS-METOPROLOL-L
"
PMS-MISOPROSTOL
PMS-MOCLOBEMIDE
PMS-NAPROXEN
PMS-NEFAZODONE
PMS-NIZATIDINE
PMS-NORTRIPTYLINE
PMS-NYSTATIN
PMS-OXTRIPHYLLINE
PMS-OXYBUTYNIN
PMS-PHENOBARBITAL
PMS-PINDOLOL
"
PMS-PIROXICAM
PMS-POLYTRIMETHOPRIM
Page
191
160
134
76
77
76
77
138
92
93
147
62
56
3
135
98
105
98
99
93
57
132
132
171
106
84
116
126
30
139
79
79
214
144
140
183
117
144
144
114
57
107
79
172
117
111
148
50
51
50
51
12
149
100
86
81
100
149
101
4
203
202
89
52
53
81
132
PRODUCT NAME
PMS-POTASSIUM CHLORIDE
PMS-PREDNISOLONE
PMS-PROCYCLIDINE
PMS-PROPAFENONE
PMS-PROPRANOLOL
PMS-RANITIDINE
PMS-SALBUTAMOL
"
PMS-SALBUTAMOL RESPIR.SOL
PMS-SELEGILINE (EDS)
PMS-SERTRALINE
PMS-SOD POLY SULF (120ML)
PMS-SODIUM CROMOGLYCATE
PMS-SOTALOL
PMS-SUCRALFATE
PMS-SULFASALAZINE
PMS-TEMAZEPAM
PMS-TERAZOSIN
PMS-TERBINAFINE
PMS-THEOPHYLLINE
PMS-THIORIDAZINE
PMS-TIAPROFENIC
PMS-TICLOPIDINE (EDS)
PMS-TIMOLOL
PMS-TOBRAMYCIN (EDS)
PMS-TRAZODONE
"
PMS-TRIFLUOPERAZINE
PMS-VALPROIC
PMS-VALPROIC ACID
PMS-VALPROIC ACID E.C.
PMS-VERAPAMIL SR
PODOFILOX
POLYMYXIN B SO4/
BACITRACIN (ZINC)/
NEOMYCIN SO4/
HYDROCORTISONE
"
POLYMYXIN B SO4/NEOMYCIN
SO4/BACITRACIN(ZINC)
"
SO4/DEXAMETHASONE
SO4/GRAMICIDIN
"
SO4/HYDROCORTISONE
POLYMYXIN B SO4/
TRIMETHOPRIM SO4
POLYTRIM
PONSTAN
POTASSIUM CHLORIDE
POVIDONE-IODINE
PRAMIPEXOLE
DIHYDROCHLORIDE
PRANDASE
PRAVACHOL
PRAVASTATIN
PRAZIQUANTEL
PRAZOSIN
PRECISION PLUS
PRECISION XTRA
PRECISION XTRA KETONE
PRED FORTE
PRED MILD
Page
124
161
29
53
54
150
32
33
33
218
102
124
124
219
55
150
151
115
69
4
203
110
82
43
141
133
102
103
110
94
94
94
13
71
199
136
196
132
180
137
132
180
137
132
132
79
124
184
217
171
58
58
2
67
120
120
120
135
135
354
PRODUCT NAME
PREDNISOLONE
PREDNISOLONE SODIUM
PHOSPHATE
"
PREDNISONE
PREMARIN
PREMPLUS
PRESTIGE
PREVACID (EDS)
PRIMIDONE
PRINIVIL
PRINZIDE
PROBENECID
PROBETA
PROCAINAMIDE HCL
PROCAN-SR
PROCHLORPERAZINE
PROCHLORPERAZINE MESYLATE
PROCYCLID
PROCYCLIDINE HCL
PROFASI HP (EDS)
PROGESTERONE (MICRONIZED)
PROGRAF (EDS)
PROLOPA
PROLOPRIM
PROMETRIUM (EDS)
PRONESTYL-SR
PROPADERM
PROPAFENONE HCL
PROPANTHEL
PROPANTHELINE BROMIDE
PROPINE
PROPOXYPHENE
PROPRANOLOL
"
"
PROPYLTHIOURACIL
PROPYL-THYRACIL
PROSCAR
PROSTIGMIN
PROTOPIC (EDS)
PROTROPIN (EDS)
PROVERA
PROZAC
PULMICORT NEBUAMP
PULMOZYME (EDS)
PURINETHOL (EDS)
PVF-K 500
PYRANTEL PAMOATE
PYRETHINS/PIPERONYL
BUTOXIDE/
PETROLEUM DISTILLATE
PYRIDIUM
PYRIDOSTIGMINE BROMIDE
PYRIDOXINE HCL
PYRIDOXINE HCL
PYRIMETHAMINE
PYRVINIUM PAMOATE
QUESTRAN
QUESTRAN LIGHT
QUETIAPINE
QUIBRON-T/SR
QUINAPRIL HCL
QUINAPRIL HCL/
HYDROCHLOROTHIAZIDE
QUINIDINE BISULFATE
Page
135
135
136
161
161
166
166
120
148
89
64
65
127
140
53
53
108
109
29
29
168
175
219
215
21
175
53
189
53
30
30
138
88
35
54
67
177
177
212
28
200
174
175
98
159
159
130
25
10
2
183
196
28
206
206
19
2
56
56
109
203
67
67
54
PRODUCT NAME
QUINIDINE SO4
QUININE SO4
QUININE-ODAN
QVAR
R&C SHAMPOO/CONDITIONER
RABEPRAZOLE SODIUM
RALOXIFENE HCL
RAMIPRIL
RANITIDINE
RAPAMUNE (EDS)
RATIO-ALPRAZOLAM
RATIO-AMIODARONE
RATIO-AVIRAX
"
RATIO-AZATHIOPRINE
RATIO-BACLOFEN
RATIO-BECLOMETHASONE
RATIO-BECLOMETHASONE AQ.
RATIO-BRIMONIDINE
RATIO-BUSPIREX
RATIO-CAPTOPRIL
"
RATIO-CHLORPROMANYL-40
RATIO-CLINDAMYCIN
RATIO-CLOBAZAM
RATIO-CLOBETASOL
RATIO-CLONAZEPAM
RATIO-CODEINE
RATIO-DEPROIC
RATIO-DESIPRAMINE
"
RATIO-DEXAMETHASONE
RATIO-DILTIAZEM
RATIO-DILTIAZEM CD
"
RATIO-DIPIVEFRIN
RATIO-DOMPERIDONE
RATIO-DOXAZOSIN
RATIO-DOXEPIN
RATIO-DOXYCYCLINE
RATIO-ECTOSONE
RATIO-ECTOSONE MILD
RATIO-EMTEC
RATIO-FAMOTIDINE
RATIO-FLUNISOLIDE
RATIO-FLUOXETINE
RATIO-FLURBIPROFEN
RATIO-FLUVOXAMINE
"
RATIO-GEMFIBROZIL
RATIO-GLYBURIDE
RATIO-HALOPERIDOL
RATIO-INDOMETHACIN
"
RATIO-IPRATROPIUM
"
RATIO-LACTULOSE (EDS)
RATIO-LENOLTEC #4
RATIO-LENOLTEC NO.2
RATIO-LENOLTEC NO.3
RATIO-LEVOBUNOLOL
RATIO-LOVASTATIN
RATIO-METFORMIN
RATIO-METHOTREXATE
Page
54
19
19
159
183
149
168
68
150
218
112
46
9
13
14
210
36
159
134
139
116
60
61
6
104
12
92
191
90
83
94
96
97
160
48
49
50
138
147
62
97
11
190
190
83
148
135
98
78
98
99
57
171
106
78
79
30
139
30
144
83
82
82
140
215
57
172
199
355
PRODUCT NAME
RATIO-MOCLOBEMIDE
RATIO-MORPHINE
RATIO-MORPHINE SR
RATIO-MPA
RATIO-NADOLOL
RATIO-NAPROXEN
"
RATIO-NEOTOPIC
RATIO-NORTRIPTYLINE
RATIO-NYSTATIN
"
RATIO-ORCIPRENALINE
RATIO-PENTOXIFYLLINE
RATIO-PEPTOL
RATIO-PRAZOSIN
RATIO-PREDNISOLONE
RATIO-RANITIDINE
RATIO-SALBUTAMOL
"
RATIO-SALBUTAMOL HFA
"
RATIO-SERTRALINE
RATIO-SOTALOL
RATIO-SULFASALAZINE
RATIO-TEMAZEPAM
RATIO-TERAZOSIN
RATIO-TIAFEN
RATIO-TOPILENE
RATIO-TOPISALIC
RATIO-TOPISONE
RATIO-TRAZODONE
"
RATIO-VALPROIC
REBETRON (EDS)
REBIF (EDS)
REGULAR ILETIN II, PORK
RELAFEN (EDS)
REMERON
REMICADE (EDS)
REMINYL (EDS)
RENAGEL (EDS)
RENEDIL
REPAGLINIDE
REQUIP
RESCRIPTOR (EDS)
RESONIUM CALCIUM
RESTORIL
RETIN A
RETIN A (EDS)
RETROVIR (EDS)
RHINALAR
RHINARIS-F
RHINOCORT AQUA
RHINOCORT TURBUHALER
RHODACINE
RHODIS EC
RHODIS SR
RHO-HALOPERIDOL
RHO-NITRO PUMPSPRAY
RHOTRAL
RHOTRIMINE
RHOXAL-ATENOLOL
RHOXAL-CLONAZEPAM
RHOXAL-DILTIAZEM CD
Page
111
12
100
87
86
175
51
80
81
180
101
4
182
31
43
147
67
135
150
32
33
32
32
33
102
55
151
115
69
82
141
189
190
189
102
103
94
213
214
169
80
99
213
213
218
63
173
218
15
124
115
197
197
17
135
135
134
134
79
79
79
106
73
46
103
47
90
49
PRODUCT NAME
RHOXAL-DILTIAZEM CD
RHOXAL-FAMOTIDINE
RHOXAL-FLUOXETINE
RHOXAL-LOPERAMIDE
RHOXAL-METFORMIN
RHOXAL-NABUMETONE (EDS)
RHOXAL-NITRAZEPAM
RHOXAL-RANITIDINE
RHOXAL-SALBUTAMOL RES.SOL
RHOXAL-SERTRALINE
RHOXAL-SOTALOL
RHOXAL-TICLOPIDINE (EDS)
RHOXAL-TIMOLOL
RHOXAL-VALPROIC
RIDAURA
RIFABUTIN
RISEDRONATE SODIUM
RISPERDAL
RISPERIDONE
RITALIN
RITALIN SR
RITONAVIR
RIVASTIGMINE
RIVOTRIL
RIZATRIPTAN BENZOATE
ROCALTROL (EDS)
ROFECOXIB
ROFERON-A (EDS)
ROPINIROLE HCL
ROSASOL
ROSIGLITAZONE MALEATE
RTP-CYCLOBENZAPRINE (EDS)
RYTHMODAN
RYTHMODAN-LA
RYTHMOL
S.A.S. 500
SAB-DICLOFENAC
SAB-INDOMETHACIN
SAB-LEVOBUNOLOL
SAB-PENTASONE
SABRIL
SAB-TOBRAMYCIN (EDS)
SAIZEN (EDS)
SALAZOPYRIN
SALBUTAMOL SO4
SALMETEROL XINAFOATE
SALMETEROL XINAFOATE/
SALOFALK
SANDOMIGRAN
SANDOMIGRAN DS
SANDOSTATIN (EDS)
SANS-ACNE
SANSERT (EDS)
SAQUINAVIR
SARNA HC
SCABENE
SCOPOLAMINE
SECOBARBITAL SODIUM
SECONAL
SECTRAL
SELECT 1/35
SELEGILINE HCL
SELEXID (EDS)
SEPTRA
Page
50
148
98
144
172
12
80
90
150
33
102
55
43
141
94
154
217
217
109
109
111
111
18
218
90
35
207
81
24
218
184
173
36
50
50
53
151
77
79
140
136
95
133
174
151
32
33
33
151
151
34
34
216
216
180
34
18
194
183
146
112
112
46
164
218
11
21
356
PRODUCT NAME
SEPTRA
SEPTRA D.S.
SERC
SEREVENT (EDS)
SEREVENT DISKUS (EDS)
SEROQUEL (EDS)
SERTRALINE HYDROCHLORIDE
SERZONE
SEVELAMER HCL
SIBELIUM (EDS)
SIMVASTATIN
SINEMET
SINEMET CR
SINEQUAN
SINGULAIR (EDS)
SINTROM
SIROLIMUS
SLOW TRASICOR
SLOW-K
SODIUM AUROTHIOMALATE
SODIUM CROMOGLYCATE
"
SODIUM FLUORIDE
SODIUM FUSIDATE
SODIUM NITROPRUSSIDE
REAGENT
SODIUM POLYSTYRENE
SULFONATE
SODIUM SULAMYD
SOFRACORT
SOFRA-TULLE
SOF-TACT
SOLGANAL
SOLU-CORTEF
SOMATREM
SOMATROPIN
SORIATANE (EDS)
SOTACOR
SOTALOL HCL
SPIRONOLACTONE
SPIRONOLACTONE/
HYDROCHLOROTHIAZIDE
SPORANOX (EDS)
STARLIX (EDS)
STATEX
"
"
"
STATICIN
STAVUDINE
STEMETIL
"
STIEVA-A
STIEVA-A FORTE (EDS)
STILBESTROL
STILBOESTROL
SUCRALFATE
SULCRATE
SULCRATE SUSPENSION PLUS
SULFACETAMIDE (SODIUM)
SULFACETAMIDE (SODIUM)/
COLLOIDAL SULPHUR
SULFACETAMIDE SODIUM/
SULFACET-R
SULFAMETHOXAZOLE/
TRIMETHOPRIM
SULFANILAMIDE/AMINACRINE
Page
22
22
71
33
33
109
102
100
218
34
58
215
215
97
215
40
218
66
124
154
140
219
219
180
121
124
133
136
180
120
154
161
174
174
199
55
55
126
68
4
172
85
86
87
88
180
17
108
109
197
197
168
168
150
150
150
133
184
137
184
21
PRODUCT NAME
HCL/ALLANTOIN
SULFASALAZINE
(SALICYLAZOSULFAPYRIDINE)
SULFINPYRAZONE
"
SULINDAC
SUMATRIPTAN
SUPRAX (EDS)
SUPREFACT (EDS)
SURESTEP
SURGAM
SURMONTIL
SUSTIVA (EDS)
SYMMETREL
SYNACTHEN DEPOT
SYNALAR
SYNALAR REGULAR
SYNAREL (EDS)
SYNPHASIC
SYNTHROID
TACROLIMUS
"
TALWIN
TAMBOCOR
TAMSULOSIN HCL
TAPAZOLE
TARO-CARBAMAZEPINE
TARO-SONE
TARO-WARFARIN
"
TAZAROTENE
TAZORAC
TEGRETOL
"
TEGRETOL CR (EDS)
TELMISARTAN
TELMISARTAN/
HYDROCHLOROTHIAZIDE
TEMAZEPAM
TENORETIC
TENORMIN
TEQUIN (EDS)
TERAZOL-3
TERAZOL-3 DUAL-PAK
TERAZOL-7
TERAZOSIN HCL
TERBINAFINE HCL
"
TERBUTALINE SO4
TERCONAZOLE
TESTOSTERONE ENANTHATE
TESTOSTERONE UNDECANOATE
TETRABENAZINE
TETRACYCLINE
TEVETEN
THEOCHRON
THEO-DUR
THEOLAIR LIQUID
THEOPHYLLINE (ANHYDROUS)
THIAMINE HCL
THIORIDAZINE
THIOTHIXENE
THYROID
THYROID
Page
184
151
42
127
82
35
5
211
120
82
103
15
31
14
173
192
192
216
164
176
200
219
89
50
219
177
91
92
189
41
42
200
200
91
92
92
68
68
115
59
47
19
183
183
183
69
4
182
34
183
162
162
162
162
219
12
63
203
203
203
203
207
110
110
176
176
357
PRODUCT NAME
TIAPROFENIC ACID
TIAZAC
"
TICLID (EDS)
TICLOPIDINE HCL
TILADE
TIMOLIDE
TIMOLOL MALEATE
"
"
TIMOLOL MALEATE
TIMOLOL MALEATE/
PILOCARPINE HYDROCHLORIDE
TIMOLOL/
HYDROCHLOROTHIAZIDE
TIMOPTIC
TIMOPTIC-XE
TIMPILO
TINZAPARIN SODIUM
TIZANIDINE HCL
TOBI (EDS)
TOBRADEX (EDS)
TOBRAMYCIN
"
TOBRAMYCIN/DEXAMETHASONE
TOBREX (EDS)
TOFRANIL
TOLBUTAMIDE
TOLTERODINE L-TARTRATE
TOPAMAX
TOPICORT
TOPICORT MILD
TOPIRAMATE
TOPSYN
TRACLEER (EDS)
TRANDATE
TRANDOLAPRIL
TRANSDERM-NITRO 0.2
TRANSDERM-NITRO 0.4
TRANSDERM-NITRO 0.6
TRANSDERM-V
TRANYLCYPROMINE SO4
TRASICOR
TRAVATAN
TRAVOPROST
TRAZODONE
TRAZOREL
"
TRENTAL
TRETINOIN
TRIADERM
TRIAMCINOLONE
"
"
TRIAMCINOLONE
HEXACETONIDE
TRIAMTERENE/
HYDROCHLOROTHIAZIDE
TRIAZOLAM
TRI-CYCLEN
TRIDESILON
TRIFLUOPERAZINE
TRIFLURIDINE
TRIHEXYPHENIDYL HCL
TRIKACIDE
TRIMEPRAZINE TARTRATE
Page
82
49
50
43
43
216
69
55
69
141
141
141
69
141
141
141
41
37
3
137
3
133
137
133
99
173
202
94
192
192
94
193
211
64
70
72
72
72
146
102
66
141
141
102
102
103
43
197
195
161
136
162
195
162
162
70
115
165
191
110
133
29
21
219
PRODUCT NAME
TRIMETHOPRIM
TRIMIPRAMINE
TRINIPATCH 0.2
TRINIPATCH 0.4
TRINIPATCH 0.6
TRIPHASIL
TRIQUILAR
TRIZIVIR (EDS)
TRUSOPT
T-STAT
TYLENOL WITH CODEINE ELX
ULCIDINE
ULTRADOL (EDS)
ULTRAMOP (EDS)
ULTRASE MS4
ULTRASE MT12
ULTRASE MT20
ULTRAVATE (EDS)
UNIDET (EDS)
UNIPHYL
URECHOLINE
UREMOL-HC
URISPAS (EDS)
URSO (EDS)
URSODIOL
VAGIFEM
VALACYCLOVIR
VALISONE
VALIUM
VALPROATE SODIUM
VALPROIC ACID
VALSARTAN
VALSARTAN/
HYDROCHLOROTHIAZIDE
VALTREX
VANCERIL INHALER
VANCOCIN (EDS)
VANCOMYCIN HCL
VANQUIN
VASERETIC
VASOCIDIN
VASOTEC
VENLAFAXINE HCL
VENTODISK
VENTOLIN
"
VENTOLIN RESPIRATOR SOLN.
VERAPAMIL HCL
"
VERMOX
VIADERM-KC
VIBRAMYCIN
VIBRA-TABS
VIDEX (EDS)
VIDEX EC (EDS)
VIGABATRIN
VIOKASE
VIOXX (EDS)
VIRACEPT (EDS)
VIRAMUNE (EDS)
VIROPTIC
VISKAZIDE
VISKEN
"
Page
21
103
72
72
72
163
163
15
138
180
83
82
82
83
148
77
200
145
145
145
193
202
203
28
194
202
220
220
166
14
190
114
94
94
70
70
14
159
13
13
2
62
137
62
104
32
32
32
33
33
55
70
2
195
11
11
16
16
95
146
81
18
15
133
66
52
53
358
PRODUCT NAME
VITAMIN A
VITAMIN A
VITAMIN A ACID
VITAMIN A ACID (EDS)
VITAMIN B1
VITAMIN B12
VITAMIN B6
VITAMIN D
VIVELLE (EDS)
VIVOL
VOLTAREN
"
VOLTAREN OPHTHA (EDS)
VOLTAREN-SR
"
WARFARIN
WARTEC
WELLBUTRIN SR (EDS)
WESTCORT
WINPRED
XALATAN
XANAX
XATRAL
ZADITEN (EDS)
ZAFIRLUKAST
ZALCITABINE
ZANAFLEX (EDS)
ZANTAC
ZARONTIN
ZAROXOLYN
ZERIT (EDS)
ZESTORETIC
ZESTRIL
ZIAGEN (EDS)
ZIDOVUDINE
ZITHROMAX (EDS)
ZOCOR
ZOLADEX (EDS)
ZOLMITRIPTAN
ZOLOFT
ZOMIG (EDS)
ZOMIG RAPIMELT (EDS)
ZOVIRAX
ZOVIRAX WELLSTAT PAC
ZOVIRAX ZOSTAB PAC
ZUCLOPENTHIXOL ACETATE
ZUCLOPENTHIXOL DECANOATE
ZUCLOPENTHIXOL
DIHYDROCHLORIDE
ZYLOPRIM
ZYPREXA (EDS)
ZYPREXA ZYDIS (EDS)
ZYVOXAM (EDS)
Page
206
206
197
197
207
206
206
207
167
114
76
77
139
76
77
41
199
95
194
161
139
112
210
214
220
17
37
150
91
126
17
65
64
15
17
7
58
213
35
102
35
35
13
14
14
110
110
111
210
107
107
13
FORMULARY UPDATES
Formulary Updates
1
Please place update sticker here
2
360
3
4
361
Formulary Updates
Formulary Updates
5
6
362
7
8
363
Formulary Updates
Formulary Updates
9
10
364
11
12
365
Formulary Updates
Formulary Updates
13
14
366
15
16
367
Formulary Updates
Formulary Updates
17
18
368
19
20
369
Formulary Updates
Formulary Updates
21
22
370
23
24
371
Formulary Updates
Formulary Updates
25
26
372
27
28
373
Formulary Updates
Formulary Updates
29
30
374
31
32
375
Formulary Updates
UPDATE INDEX
A
Update Index
B
378
C
Update Index
D
379
E
Update Index
F
380
G
Update Index
H
381
I
Update Index
J
382
K
Update Index
L
383

TABLE OF CONTENTS - Drug Plan

Transcription

Similar documents

Formulary 51st Edition - Drug Plan

Formulary 50th Edition - Drug Plan

Formulary 54th Edition - Drug Plan

Anatomical Classification Guidelines V2013 EPHMRA

Fidelis Care 2016 Formulary (List of Covered Drugs)